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More Questions about Study for CT Scanning for Lung Cancer


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http://blogs.wsj.com/health/2008/10/03/ ... ng-cancer/


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More Questions About Study of CT Screening for Lung Cancer

Posted by Jacob Goldstein

Add another asterisk to that high-profile research from a few years back that suggested smokers might benefit from CT screening to detect lung cancer.

This week, a letter to the journal The Oncologist questioned data from a follow-up study, and the editor of the journal called again for an audit of the findings.

For those who are just tuning in: In 2006, researchers reported in the New England Journal of Medicine that in a population at risk for lung cancer, CT screening “could prevent some 80% of deaths from lung cancer.” Their conclusion was based on a study that screened thousands of smokers for lung cancer.

The researchers emphasized that there were eight patients who were diagnosed with stage I lung cancer and chose not to be treated, and all eight died within five years — a far worse outcome than those who were diagnosed with stage I cancer and did choose to be treated.

But earlier this year, the researchers wrote a letter to the NEJM to say that only three of the eight patients were confirmed with stage I disease in accordance with the study protocol.

The new stuff concerns a follow-up study published last year in The Oncologist. In that study, the authors listed 13 patients with stage I disease who chose not to be treated, all of whom died. But in a letter published in the current issue of the journal, the author, Claudia Henschke of Weill Cornell Medical College, says the five additional patients included in the Oncologist paper also failed to meet the study protocol for confirming stage I disease.

An editorial in The Oncologist says most of the untreated patients identified as having stage I disease may in fact have had later stage cancer where screening wouldn’t help save lives. And the editorial calls for an audit of the findings. “It’s gotten to the point where the data are so messy that the only thing that will resolve it is to have an independent audit,” Bruce Chabner, a Harvard/Mass General oncologist who’s the editor-in-chief of The Oncologist, told the Health Blog.

Meanwhile, a separate letter to the editor, by Peter Bach of Memorial Sloan-Kettering Cancer Center, questions other elements of the follow-up study. Bach argues that there is only a 1.6% chance that all 13 of the reported deaths among untreated patients would have occurred before the end of the study’s follow-up period. This very low probability suggests that the data “may be biased,” Bach writes. It is possible, Bach suggests, that the researchers added these the 13 patients to the count after they died. “n this case the bias would ensure that the death rate is always 100% (because no new subjects are added until they die),” he writes.

Henschke is traveling this week and wasn’t available for comment, a Cornell spokesman told the Health Blog.

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(Wall Street Journal, WSJ Health Blog, Posted by Jacob Goldstein, October 3, 2008)


The information contained in these articles may or may not be in agreement with my own opinions. They are not posted as medical advice of any kind.

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