Will the chest CT soon be part of the routine physical?

A recent NEJM study suggests that it may save lives, but there are downsides to routine chest CTs:

“Everyone knows we can pick up things better with screening,” said Dr. Elliott Fishman, a professor of radiology and oncology at Johns Hopkins Hospital in Baltimore. “But is picking up the same thing as curing? If I pick up a tumor that is one centimeter today and you live five years or I pick it up four years later and you live one year, it’s the same thing.”

Even evaluating patients with suspicious CT results can be risky, more dangerous, say, than evaluating women with suspicious lumps on a mammogram, said Dr. David Johnson, deputy director of the cancer center at Vanderbilt University and a past president of the American Society of Clinical Oncology.

In Dr. Henschke’s study, doctors investigated more than 4,000 nodules in patients, finding about 400 early-stage cancers.

“This is not sticking a needle in a breast,” Dr. Johnson said. “It is sticking a needle in the chest, where it can collapse a lung.” In some cases, that is followed by surgery to further evaluate a lump. “How many people do we subject to needless evaluations?” Dr. Johnson asked.

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