Proponents of screening say the scans could save thousands of lives, and people at risk of lung cancer should be able to get the exams — and insurance companies should pay for them — in consultation with their doctors.
Critics of wide-scale testing acknowledge that CT screening represents an exciting advance but argue that it remains far from clear whether the benefits will outweigh the risks in the real world. Screening millions of Americans could do more harm than good by spawning a wave of false alarms that prompt costly, dangerous and needless follow-up testing, biopsies and surgeries, they say.
More than 222,000 Americans receive lung cancer diagnoses each year, and more than 157,000 die from the disease — more than from cancers of the breast, colon and prostate combined. Lung cancer has remained notoriously difficult to treat, in part because it is often diagnosed too late.
There are about 100 million current and former smokers in the United States, all of whom are at increased risk. Many more might be prone to the disease because of family history or exposure to substances such as radon and asbestos.
CT scans create three-dimensional images of the lungs, instead of the two-dimensional perspectives captured by chest X-rays. Scans are more likely to spot small tumors, boosting the chances of survival.
In November, the National Cancer Institute announced it was stopping
the $250 million National Lung Screening Trial, which was testing the approach in 53,500 men and women in 33 sites across the United States, when it became clear the scans could slash the death rate by a stunning 20 percent compared with old-fashioned chest X-rays.
Even though many hospitals and radiology practices can do CT scans because they offer them for other purposes, officials said that more analysis was needed to answer many questions, including precisely who might benefit and under what conditions.
The scans produced false alarms in about 40 percent of cases in the study. While screening saved 88 lives among the trial participants, 16 patients died from apparent complications from follow-up procedures, including six who did not have cancer.
“Screening for lung cancer saves lives, but it is a double-edged sword,” said Otis W. Brawley, the American Cancer Society’s chief medical and scientific officer. “There’s a huge benefit, but there’s also a documented risk and a documented harm.”
Leading medical groups are urging doctors to wait until experts carefully review the findings. They also want the results of a federally funded cost-benefit analysis, which is underway. Insurers, including the government’s powerful and influential Centers for Medicare and Medicaid Services, say they will review the outcomes of those deliberations before deciding whether to pay for scans.
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