A U.S. medical panel for the first time endorsed annual CT scans to detect lung cancer in current and former smokers, an effort to tackle the nation's biggest cancer killer that contrasted with a new caution from a separate medical group about overdiagnosis and overtreatment of cancer.
The U.S. Preventive Services Task Force, whose recommendations determine which therapies and tests must be provided by insurers under the Obama administration's new health law, concluded that about 20% of lung-cancer deaths might be avoided through early detection and treatment.
The recommendations drew support even from some doctors who are often skeptical of broad cancer screening. But a separate panel of doctors advising the National Cancer Institute voiced concerns that in cancer care generally, too much screening and too much early treatment can sometimes be harmful to patients.
Writing in the Journal of the American Medical Association, authors Laura J. Esserman, Ian M. Thompson Jr. and Brian Reid said, "An ideal screening intervention focuses on detection of disease that will ultimately cause harm" and for which treatments "are more effective in early-stage disease."
The JAMA authors also said the word "cancer" itself is overused, can frighten patients and ought to be reserved for disease that has a "reasonable likelihood" of being lethal.
The authors didn't specifically discuss the federal task-force recommendations about lung-cancer screening, but their conclusions could affect how the recommendations are carried out.
"Physicians, patients and the general public must recognize that overdiagnosis is common and occurs more frequently with cancer screening. Overdiagnosis, or identification of indolent cancer, is common in breast, lung, prostate and thyroid cancer," the authors wrote.
The federal preventive-services task force, which consists of private physicians appointed by the U.S. Department of Health and Human Services, acknowledged risks but concluded that low-dose computed tomography, or CT, imaging "reduced lung cancer mortality by 20% and all-cause mortality by nearly 7%." Its findings are being published Tuesday in the Annals of Internal Medicine.
"We believe the benefits do outweigh the harms," said Michael LeFevre, co-vice chairman of the task force. He said the decision was largely based on a 2011 study sponsored by the National Cancer Institute.
The task force recommended that people consider screening for lung cancer if they are current or former smokers between the ages of 55 and 79, and have smoked the equivalent of a pack of cigarettes a day for 30 years and have smoked within the past 15 years. Lung screening is already available at some hospitals and often costs in the range of $100 to $300 a test.
Dr. LeFevre made the conservative estimate that "we might be able to prevent 20,000 deaths" yearly. It is estimated that about 37% of American adults are current or former smokers, and lung cancer is the leading cause of cancer death in the U.S.
"I think that in the main, this does make sense," said H. Gilbert Welch, a Dartmouth medical professor and author of "Overdiagnosed: Making People Sick in the Pursuit of Health." He cited three factors that make CT scans for lung cancer compelling: lung cancer's high death rate; a clearly identifiable high-risk patient group; and the fact that treatments for advanced lung cancer are mostly unsuccessful.
Another doctor who has expressed caution about screening concurred. "Although I am a skeptic, the level of evidence is pretty high," said Barnett Kramer, director of the division of cancer prevention at the NIH's National Cancer Institute. Dr. Kramer helped create the study, called the National Lung Screening Trial, that led to the new recommendation.
But he stressed that "the benefit of stopping smoking is much, much larger than the benefit of CT screening." People who kick the habit can also reduce their risk of death from other cancers, heart disease and stroke, he said.
Other doctors recommended that patients find their own personal risk of lung cancer before deciding on screening. One site that enables such assessment, from Memorial Sloan-Kettering Cancer Center in New York, is http://www.mskcc.org/lung-screening-tool.
Write to Thomas M. Burton at tom.burton@wsj.com
A version of this article appeared July 29, 2013, on page A2 in the U.S. edition of The Wall Street Journal, with the headline: Panel Backs CT Screening for Lung Cancer.
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