Lahey Radiologist On Lung Cancer CT: Good News And Hard Questions

Big news today on lung cancer, the number one cancer killer. A federal study of more than 50,000 current or former smokers found that low-dose “spiral CT” scans cut the death rate by 20 percent compared to screening with regular chest X-rays.

The Associated Press reports: The difference was significant enough that the researchers ended the study early, but the National Cancer Institute said that “it’s not clear that all smokers should get the scans, which aren’t risk-free.”

We asked Dr. Christoph Wald, of the Lahey Clinic, for his take on the findings. What do they mean for the public?

It’s early days yet, he said, and it will likely take months for the full data to be published. But for people who fit the high-risk profile of the subjects of the study — ages 55 to 74, and with a smoking history amounting to the equivalent of a pack a day for 30 years — “We can say that if you do what they did in the trial, get three consecutive low-dose CT scans, you have a very significant mortality benefit over the next five ensuing years.”

Dr. Christoph Wald of the Lahey Clinic

Dr. Wald expects clinicians to take a look at which patients in their practice fit the high-risk profile of the patients in the federal trial, and the doctors may well recommend CT screening to those patients. “At this time, since there are no national guidelines, it’s between the physician and the patient to decide how they want to incorporate this good new information into their physician-patient relationship,” he said.

Now for the hard parts:

-What if you’re at lower risk than the older, 30-pack-year patients in the trial? Younger, or less of a smoker? The trial offers no guidance on whether to do spiral CT screening, Dr. Wald said.

-Cost: A spiral CT costs several hundred dollars, compared to a typical chest X-ray, which generally costs $50-$100.

-And here’s the really hard part: Currently, insurance does not generally cover CT for screening purposes, only if you have symptoms or a chest X-ray abnormality. That is likely to change with this excellent new data, but for now, Dr. Wald said, “There’s going to be a bit of a confict potential for the time being. If patients walk into our office on Monday wanting this screening CT, we’re going to have an issue because we can’t get paid for it. It will put the providers in a bad spot initially.”

The Politics Of Prostate Cancer Screening

Have guidelines over prostate cancer screening been bogged down by politics?

The Wall Street Journal blog reports that a staffer for a federal task force that was scheduled to vote on the controversial issue of prostate cancer screening is quitting the panel in protest.

Family medicine physician Kenneth Lin says in a blog post that he will quit as a staff support person for the United States Preventive Services Task Force, which was supposed to meet for a vote on the risks and benefits of prostate cancer screening. Instead, the meeting was cancelled. In his post, Lin suggests the issues surrounding the task force signal that “politics trumped science.”

You will no doubt remember what happened the last time the task force issued guidelines, on mammograms for breast cancer screening? (The panel late last year recommended that only women aged 50 to 74 need routine mammograms every other year and that breast self-examinations shouldn’t be taught.) It created a political firestorm with many women screaming that the new guidelines were part of a medical plot against them and simply designed to save money without considering their health and indeed, their lives.

Fast forward to today, Election Day 2010, when the last thing certain candidates need is a massive revolt by any voter with a prostate.

Here’s how The Journal explains the great cancelled-meeting controversy:

We broke the story last week that the USPSTF had canceled the Nov. 1-2 meeting, which USPSTF Chairman Ned Calonge said was due to scheduling conflicts. He had no comment then on whether the proximity of the meeting to Election Day played any role in the decision. Emails sent this morning to Calonge, the AHRQ and Lin weren’t immediately returned.

Calonge told us last week he was hoping to have a conference call to “keep the work moving forward” and then reconvene again in March for the next regularly scheduled meeting. That should include a vote on prostate-cancer screening.

As we also reported last week, last November the USPSTF voted at first to give prostate-cancer screening a “D” recommendation for all age groups, meaning the group recommends against screening for all age groups. Currently the USPSTF has an “I” rating for prostate-cancer screening, which means the current evidence is insufficient to assess the balance of benefits and harms, for men younger than 75. For older men, the rating is “D.”