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Low-Dose CT Screening for Lung Cancer Carries Notable Overdiagnosis Risk — Physician’s First Watch

Medical News |
December 10, 2013

Low-Dose CT Screening for Lung Cancer Carries Notable Overdiagnosis Risk

By Amy Orciari Herman

Nearly 20% of lung cancers detected by low-dose computed tomography screening might be indolent, according to a JAMA Internal Medicine study. The researchers say such overdiagnoses should be noted when discussing the potential harms of CT screening.

Using data from the National Lung Screening Trial, the researchers examined lung cancer diagnoses among 50,000 high-risk adults who were randomized to three annual screenings with either low-dose CT or chest radiography. During some 6 years' follow-up, 1089 lung cancers were reported in the CT group and 969 in the radiography group.

Although low-dose CT reduced lung cancer mortality by 20% compared with radiography, there was an 18.5% chance that any lung cancer detected by CT was an overdiagnosis, the researchers estimate.

Reader Comments (1)

Andrea Borondy Kitts, BSME, MS Other, Other, Independent Lung Cancer Advocate

The headlines for the JAMA paper on overdiagnosis were over-hyped and the JAMA paper itself was biased. After reading the JAMA paper, as an engineer, I am amazed it was peer reviewed and published. The assumption, that all of the additional lung cancers found by LDCT scans over those found by CXR are over diagnosis, is flawed. If that were true, there would not have been a difference in mortality between the screening arms. The NLST only did 3 screens, 1 prevalence screen followed by 2 annual incidence screens. Lung cancers found with LDCT screening were 70% Stage 1 and 2 and 30% Stage 3 and 4. The extra cancers found by LDCTarm vs CXR arm were essentially all of the early stage ones. Follow-up cancers found post screening in the LDCT screening arm reverted back to 37% early stage and 63% late stage. (The National Lung Screening Trial Research Team . N Engl J Med 2011;365:395-409). To assume that the early stage lung cancers found with LDCT screening were all over diagnosis conflicts with the 20% reduction in mortality achieved with LDCT scans. The early stage lung cancers are the most curable ones and constitute the reduction in mortality. Also of interest is that at least one of the authors, William J. Patz, may have an undisclosed conflict of interest. He is the author of 5 patents on an alternate method for lung cancer screening. http://patents.justia.com/inventor/edward-f- patz. I believe some in the medical community are trying to undermine lung cancer screening just as it seems to be poised to become a reality..

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