Benefits of screening for lung cancer with CT are not proven

DURHAM, N.C. -- The medical literature does not support the widely held belief that an advanced screening technique called "CT" (computed tomography) can save lives simply because it detects lung cancers at a smaller size than other screening techniques, according to researchers at Duke University Medical Center and the Mayo Clinic.

CT scans have a finer resolution and can display smaller nodules more clearly and earlier than conventional chest X-rays, said the authors. Yet neither screening technique has ever been validated as a means of saving lives, said Edward Patz, M.D., professor of radiology and professor in pharmacology/cancer biology at Duke.

"Finding a lung cancer when it is smaller does not necessarily mean the cancer is at an earlier stage of development," said Patz. "The genetic characteristics of a tumor likely dictate its behavior more than its size. Smaller lung tumors can represent late-stage lung cancer."

Patz and co-author Stephen J. Swenson, M.D., of the Mayo Clinic, published their analysis of lung cancer screening studies in the June 1, 2004, issue of the Journal of Clinical Oncology.

Patz, Swenson and James Herndon, Ph.D., a statistician at Duke, analyzed the two major observational studies being conducted to screen for lung cancer using CT. Based on these ongoing trials and data from previously published five-year survival rates, the authors devised a model to predict the lung cancer mortality rate among patients who had been screened using CT.

Their analysis of the two CT studies estimated that between 4.1 and 5.5 patients per thousand would die of lung cancer. This estimate is close to the established lung cancer mortality rate of 3.9 to 4.4 deaths per thousand found in studies that don't use CT to screen patients.

Their findings call into question the growing practice of charging smokers for expensive CT scans to detect lung cancers. Moreover, their assessment defies conventional wisdom, whic

Contact: Becky Levine
Duke University Medical Center

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