A landmark study shows that routine lung screening of heavy smokers and former smokers using low-dose CT scans could save thousands of lives, but the results are sure to set off a fierce debate about the cost of such testing on many overburdened health-care systems.
The U.S. National Cancer Institute studied more than 53,000 people between the ages of 55 and 74 who were deemed at high risk of developing lung cancer. The study found that screening with the three-dimensional X-rays cut deaths by 20 per cent.
Details of the study and a discussion of its implications were published last weekin the New England Journal of Medicine, lending additional weight to initial findings that were released in November.
The discussion noted that radiologists using more advanced CT equipment than was available for the study could lead to an even larger reduction in lung cancer deaths. At the same time, however, the potential for many more false positive results could rise.
Some cancer experts say the results demand that CT screening for high-risk individuals become the standard of care. "With this large a study that was so carefully done, it becomes the gold standard and it should become practice," saidStan Gerson, director at the University Hospitals Case Medical Center in Cleveland.
Caught early, there is a better chance lung cancer can be cured surgically. But it is typically not diagnosed until it has spread. Only about 15 per cent of lung cancer patients live five years or more.
Dr. Gerson and other doctors face an uphill battle to convince government programs and health insurers to pay for routine testing of millions of people, just as they try to rein in ballooning costs.
"Before public policy recommendations are crafted, the cost-effectiveness of low-dose CT screening must be rigorously analyzed," the New England Journal article said. The cost includes not just screening, but also the expense of diagnostic follow-up and treatments.
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