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CT Lung Screening? Annals Says: Yes And No

September 7, 2011
Written by: , Filed in: Chest Radiology
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A 62-year-old woman in good physical condition, a former smoker with controlled hypertension and no personal or family history of cancer, asks during a routine physical whether she should receive CT screening for lung cancer. What should her doctor say?

Annals of Internal Medicine this week presented both sides of what has become a vigorous debate—and a potential economic opportunity—ever since the preliminary results of the National Lung Screening Trial were released last November. The trial found such positive results from screening with low-dose helical CT lung scans—a 20 percent lower risk of dying from lung cancer compared to screening with standard chest X-rays—that the National Cancer Institute stopped it early.

Annals published two paired articles (both freely available in full) on Monday in its online edition. In one, James R. Jett, MD, of National Jewish Health in Denver, and David E. Midthun, MD, of Mayo Clinic in Rochester, Minnesota, advocate a qualified yes, adding:

But we would also discuss the potential risks and limitations as well as the potential benefits of screening before scheduling the test.

Based on the patient’s age and smoking history, they go so far as to advocate yearly screening “for at least 3 to 5 years; perhaps by that time, new information will be available to guide decisions on the length and frequency of screening.”

In a shot across the bow of the many clinics and hospitals who are scrambling to promote lung CT screening, Drs. Jett and Midthun caution, “Screening should be done when desired by an informed patient only in a center with expertise in interpreting imaging studies, evaluating lung nodules, and diagnosing and treating lung cancer. We do not recommend that CT screening be done at the neighborhood shopping mall or medical facility without the appropriate expertise.”

Gerard A. Silvestri, MD, of the Medical University of South Carolina in Charleston, takes the negative:

Lessons learned from prostate and breast cancer screening should remind us that the reductions in deaths expected with screening are unfortunately not as readily achievable as initially believed.

He worries that “the potential harms of false-positive findings on chest computed tomography are very real.” He suggests waiting until “guidelines for appropriate screening and management of screening-detected abnormalities” have been thoroughly thought through.

For the hypothetical patient, Dr. Silvestri suggests, “Her best bet may be to continue to run—as far and as fast away from a CT scanner as she can get.”

Both sets of authors are thoughtful, intimidatingly well-informed, and definitely worth reading.

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One Response to “CT Lung Screening? Annals Says: Yes And No”

  1. Radiology Daily»AlertArchive » WellPoint Is First To Cover CT Lung Screening on December 5th, 2011 at 10:03 am

    […] we’ve mentioned a couple of times, the trial found such positive results from screening with low-dose helical CT […]