Drs. Steven Woloshin, Lisa Schwartz and H. Gilbert Welch, Dartmouth Medical School, White River Junction Veterans Affairs Medical Center, and Norris Cotton Cancer Center, describe the history of the the New York Early Lung Cancer Action Program (NY-ELCAP), and argue that New York City has not made good use of public assets in funding the study. They conclude that NY-ELCAP will be unable to determine whether screening for lung cancer with spiral CT will save lives.
Lung cancer is the leading cause of cancer death in the US, with a five-year survival of less than 20 percent; smoking causes at least 90 percent of lung cancer deaths. In August 2000, Rudolf Giuliani, then Mayor of New York City, announced a major health initiativeNY-ELCAPto "help develop the best means for early detection and successful treatment of lung cancer." Under this initiative, 10,000 present or past heavy smokers from New York are undergoing a CT scan of the chest to try and detect lung cancer at its earliest and most treatable stage.
The authors comment, "Lung cancer is a major public-health concern. An effective screening program might save thousands of lives each year. Nonetheless, it is premature, and possibly dangerous, to move forward with spiral CT screening for lung cancer before a randomized trial has confirmed its safety. Unfortunately, NY-ELCAP does just that. We believe that the underwriting of NY-ELCAP is a poor use of public funds for three reasons. First, the study cannot tell us if screening saves lives. The fundamental design flaw [the lack of a control group] is especially distressing because it could have been corrected if New York City had required a
Contact: DMS Communications
Dartmouth Medical School