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.
Related posts:
- How does cancer screening cause harm?
- Demand a CT scan
- Should tobacco companies pay for smokers’ CT scans to screen for lung cancer?
- Waiting for the biopsy result is as stressful as being told you have cancer
- Claudia Henschke and "blood money"
- More tests is better medicine: Why the myth is hard to break
- "The distinction between survival and mortality cuts to the heart of the screening debate"
{ 3 comments }
A question. Do you guys learn basic epidemiology in med school? The guy doesn’t seem to understand the basics.
So much for the EBM. Evidence doesn’t matter, if it seems intuitively work than it must be so; if I believe in a test, then it must be useful. How is this better than any altie woo?
If doctors have problems understanding why early detection doesn’t always make a difference, how can you guys complain that patients don’t. They listen to the doctors like this guy.
Innumeracy bias again, this time from the doc. Sadly Diora, few humans, regardless of educational background can accept statistics that provide answers they don’t like.
The numbers don’t lie. Indeed they reveal that which we are unable to see when medicine is practiced anecdotally, that is, one patient at a time.
The randomized trial with biases eliminated and unequivocal outcomes (a body count) revealed no health benefit from the CT scans. Indeed, the patient’s with the CT scans didn’t live quite as long. Knowing one’s potential fate possibly had some consequences, like following a positive CT with invasive and sometimes deadly confirmatory tests. Further, if the patient’s time spent obtaining the CT scanning and followup tests, treatment ect. is counted as days of life lost (lost in the sense that they were not available to the patient to expend in a completely voluntary and utilitarian way) then the CT group would look even less favorable.
There is nothing abstract or impersonal about the results of this study as many anecdotalists would like to believe. Instead of smokers and former smokers hand-wringing over whether a CT scan can save their lives, the real lesson here is to just stop the damn smoking!
I wonder if Dr.Siegel has a stake in the Princeton Longevity Centers and their pan-ct-scans. And I wonder if they add to longevity as their name suggests, or if anyone cares whether they do or not, as long as “my patients know as early as possible, because they want to know”.
Ridiculous.
If doctors (internists, no less, those who are drilled with EBM from early in residency) don’t understand the math or translating it into clinical practice, those who DO understand it will NEVER be able to convince our patients of the right course, even when epidemiologic studies enter mainstream media in almost original unadulterated & unaltered format.
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