The lung cancer screening debate continues. An internist writes in the WSJ about the benefits of early diagnosis, even with no difference in mortality:

By the time a lung cancer is seen on an X-ray it is almost always too widespread to be operated on. Hence, the only chance for a cure is finding it before it has spread via a screening CT scan.

It is true that smokers have more false positives because of difficult-to-interpret irregularities, and so the question of how to interpret an abnormal CT scan involves the art of medicine. It is important to know who is the best chest radiologist to read the scan, and who can best perform a needle biopsy or bronchoscopy when either is necessary.

This strategy should be in place before the test is ordered. Having the best team available to order and interpret results is not a factor that can be weighed or studied in clinical research. But a CT report that tells me to repeat it in six months, or a needle biopsy for an irregular uncalcified nodule performed by a discerning expert, is far better for a clinician like me to have in hand then no CT scan or biopsy at all.

My patients want to know if they have cancer as early in the process as possible, and they want a plan to treat it. They don’t want to have to rely on mathematical projections or statistics about “hypothetical” death rates.