Should there be routine screening for lung cancer? Save money or save lives?

John Fisher
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Stopping Medical Injustice
A new study by researchers at the National Cancer Institute found that many primary care physicians' beliefs and recommendations about lung cancer are inconsistent with current evidence and guidelines.  The study reported that medical societies, including the American Cancer Society, are not recommending any lung cancer screening for asymptomatic individuals.

This major new study shows that giving smokers spiral CT scans can detect lung cancer early enough top "modestly lower their risk of death".  Corroborating these results, another study found that spiral CT screenings have been shown to reduce lung cancer deaths by 20 percent.

Research analyzed in the American Journal of Preventative Medicine found that only 67 percent of physicians recommend lung cancer screening for asymptomatic patients with smoke exposure.  Of that number, only 26 percent recommended spiral CT scans whereas the majority recommended basic chest x-rays.

Spiral CT scans rotate and view the lungs at various angles to spot growths up to half the size that a regular x-ray can.  While spiral CT scans often have their own risks, such as radiation exposure and false alarms (generally resulting in more testing adn thus more exposure to radiation), standard chest x-rays have not provenn powerful enough to reduce lung cancer deaths in surveillance screening of asymptomatic smokers.

With 200,000 new lung cancer patients diagnosed in the United States every year, and 159,000 deaths, a 20 percent reduction has the potential to create a huge impact.  While it is unknown whether this important new study will change the guidelines for lung cancer screening or change the practices of primary care physicians, I hope that physicians in primary care medicine will begin screening for lung cancer in asymptomatic patients, at least with respect to patients at high risk of lung cancer, i.e., smokers.

The American Cancer Society stated that it will review the study once it is published, and will consider modifying their guidelines as they see fit.

In this author's opinion, there is no need to screen everyone for lung cancer.  However, persons with a significant history of smoking, i.e., pack a day for thirty years, are at high risk for lung cancer particularly after the age of 45, and screening of such persons with spiral CT scans can significantly reduce their risk of dying from lung cancer.  The goal of treatment is to detect the lung cancer before it spreads to other parts of the body and such screening helps accomplish that goal, at least with respect to smokers.
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