A deplorable campaign. Currently, there is no data suggesting decreased mortality from lung cancer screening. Asking the public to “demand” a CT scan simply drives up health care costs without a demonstrable survival benefit.
(via Kidney Notes, Nick Genes also comments)
Related posts:
- "A CT scan in hand is far better then no CT scan or biopsy at all"
- Healthy heart scan
- Should you be screened for oral cancer, and are companies profiting from the uncertainty?
- An abdominal CT scan is equivalent to about 500 chest X-rays
- How much is your life worth?
- How to demand the tests you want
- Reflecting on Grand Rounds
KevinMD.com on Facebook
{ 9 comments }
hmmm . . . . there’s no real good evidence to suggest that prostate screening increases life span. But, kevinmd isn’t against that. Is it because primary care docs do a lot of them? it’s not evidence, it’s not care for patients that motivates docs. as with everyone, follow them money . . . .
Anon,
If you’re a long-time reader of this blog, you will see that my opinion of prostate cancer screening has always been of judicious use:
http://tinyurl.com/3d4hgz
I have noted the USPSTF’s “I” recommendation of prostate cancer screening on multiple occasions:
http://www.ahrq.gov/clinic/uspstf/uspsprca.htm
Thanks,
Kevin
Anon – in addition to insufficient evidence that lung cancer screening saves lives, the possibility of harm is higher for lung cancer screening.
From USPSTF: “Because of the invasive nature of diagnostic testing and the possibility of a high number of false-positive tests in certain populations, there is potential for significant harms from screening. “
Anyway, why “X of X survivors recommend” should carry any weight. Are all survivers qualified to make recommendations? IMHO, this is the same as movie stars making recommendations.
Unbelievable. The busses in LA have billboards on them saying “LUNG CT: Think of it as a mammogram for your lungs”. Apparently there is no regulation of these ads, because it’s not evidence-based or even a proven technology, right? Someone’s making the big bucks,with no regard to science or patient well-being.
OK, let’s get this straight. Neither prostate or lung cancer screening is evidenced based, but kevinmd recommends “judicious use” for one, but not the other. He makes $$ of the one he recommends judiciously. My point stands. Kevinmd is motivated apparently not by science, not by concern for patients but $$$
Oh, as for the person, who tried to distinguish between harmful CTs and unharmful prostate screenings. Ummm tell that to the man who’s prostate was unnecessarily removed and is now impotent or incontinent. Well, at least that guy made a urologist a bit richer. . . .
Anon,
You need to take up your argument with the American College of Physicians:
“Rather than screening all men for prostate cancer as a matter of routine, physicians should describe the potential benefits and known harms of screening, diagnosis, and treatment; listen to the patient’s concerns; and then individualize the decision to screen.”
http://www.annals.org/cgi/content/full/126/6/480
Primary care does not make money with prostate cancer screening.
Cases of suspected prostate cancer are referred to urologists for further evaluation and diagnostic testing.
Thanks,
Kevin
Sorry, but I have no idea how what Kevin does with regard to prostate cancer has anything to do with whether or not CT scans should be used as a screening tool for lung cancer. I think CT scans done routinely as a screening for lung cancer are not helpful and dangerous. (see NEJM article from Nov 29, 2007)
We’ll see how many smokers survive the lung resections for benign lessions.
More screening = more false positives = more surgery.
Let’s see how many people recover from lobectomies they don’t need. Then ask them how they feel about screening.
Well, it seems that Kevin MD & Mark MD see themselves as scientists/mathematicians/stat-isticians, rather than physicians whose charge is one of healing & aiding real people in medical difficulty.
Similar arguments to theirs were used in the medical community for years to forestall other now widely-used screening tests. Despite decades of debate, there is still enormous controversy over the efficacy of mammograms for women under 50 and the high number of false positives & overdiagnoses from PSA testing.
Even today, on the website of the Nat’l Cancer Institute, in the Health Professional section “Effect of Screening on Breast Cancer Mortality,” you’ll find the following after a lengthy discussion of many trials:
“In conclusion, screening for breast cancer does not affect overall mortality, and the absolute benefit for breast cancer mortality appears to be small.”
Obviously, this is not the full story as we all know now..and nothing could have held back the breast cancer activists from the AMA. For the statisticians, the same site includes discussion of all the same mathermatical biases re: mamos & mortality as are raised in lung cancer screening discussions.
As for false-positives, “unneeded” biopsies & surgeries, see Table 1, Harms of Screening Mammography on the same site. Perhaps Kevin MD & Mark MD ought to follow the advice of the American College of Physicians as respects prostate cancer screening as for lung cancer screening too:”Rather than screening all men for prostate cancer as a matter of routine, physicians should describe the potential benefits and known harms of screening, diagnosis, and treatment; listen to the patient’s concerns; and then individualize the decision to screen.”
Those at high risk for lung cancer should discuss the risks and benefits of CT screening with their doctors. Screening should only be done at facilities that have a proven track record of lung cancer screening experience, that have a multi-disciplinary team of doctors to review the scans and that follow the I-ELCAP protocol.
As a 6 year survivor of non-small cell lung cancer, thoracotomy & lobectomy diagnosed via screening, I believe the real issues are two: 1) bias and 2)money. Bias against smokers who “deserve what they get,” the real ‘elephant in the room’ and the plain fact that there is just not enough money to screen all those at high risk – yet alone recognize that more people who have NEVER smoked die from lung cancer than do people from AIDS or liver cancer or ovarian cancer.
Lung cancer and screening for it are complicated issues that deserve better than Kevin MD’s flip comments. Lung cancer kills more than 160,000 Americans annually – more people than breast, colon and prostate cancers combined. A compassionate society & compassionate doctors need to recognize the dilemma & find solutions.
Comments on this entry are closed.