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Benefits of screening for lung cancer with CT are not proven

h holds that early detection translates into saved lives. While that may be true for some cancers, there is currently no evidence to support that notion with lung cancer, said Patz.

Nearly 98 percent of all lung nodules detected on initial CT scans are not lung cancer, said Patz. Thus, finding a lung nodule -- particularly if it is small -- does not mean that it is cancerous. Even when a small nodule is found, doctors generally wait and observe the tumor until it reaches 8 millimeters before they surgically remove it or biopsy the lesion.

"At this time, given the expense and potential risks, though small, of CT screening -- and without additional data to demonstrate that this screening method actually saves patient lives -- mass screening for the general population can not be recommended," said Patz. "Just because the theory suggests that early diagnosis will result in reduced mortality doesn't mean it is validated in clinical practice."

Secondarily, Patz said their analysis does not support the logical assumption that CT screening will reduce the incidence of late stage tumors by detecting a higher percentage of tumors at an early stage. In fact, their data suggest that -- while more early stage tumors will be identified -- the number of late stage tumors will remain the same. Patz said this prediction is related to the fact that finding a small tumor earlier does not mean it is at an earlier stage of cancer.

"We should not engage the technology until we have the answers," said Patz. "Our estimates are predictive of what is likely to occur, but until we have firmer data from randomized clinical trials, we shouldn't assume that CT is beneficial or detrimental to patients at high risk for lung cancer."

There is currently a national randomized clinical trial under way at more than 40 sites nationwide to compare CT screening to chest X-rays, the first such randomized study to be conducted. As a complement to CT, Patz and his coll
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Contact: Becky Levine
levin005@mc.duke.edu
919-684-4148
Duke University Medical Center
28-May-2004


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