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Health & Medicine for Senior Citizens

Lung Cancer Screening with Low-Dose CT Produces Dangerous Overdiagnosis

False diagnosis may cause additional cost, anxiety, and sometimes death from cancer treatment

See information below news report on CT scans and lung cancer

Dec. 9, 2013 – More than 18 percent of all lung cancers detected by low-dose computed tomography (LDCT) appeared to represent an overdiagnosis, according to a study of patients between the ages of 55 and 74 years published by JAMA Internal Medicine, a JAMA Network publication. Overdiagnosis cases represent an important potential harm because they incur additional cost, anxiety, and death associated with cancer treatment.

LDCT has been shown in recent clinical trials to be an effective screening tool in some patients, but some of the tumors it finds may be indolent (slow growing) or clinically insignificant. Overdiagnosis is the detection of a cancer with a screening test that wouldn’t otherwise have become clinically apparent. It is a potential harm of screening because of the additional cost, anxiety and complications associated with unnecessary treatment, according to the study background.

 

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Edward F. Patz Jr., M.D., of Duke University Medical Center, Durham, N.C., and colleagues examined data from the National Lung Screening Trial, which compared LDCT screening vs. chest radiography (CXR) among 53,452 people at high risk for lung cancer, to estimate overdiagnosis.

Among 1,089 lung cancers reported in the LDCT group during follow-up, the authors estimated that 18.5 percent represented an overdiagnosis. They also estimated that 22.5 percent of non-small cell lung cancer detected by LDCT represented an overdiagnosis, and that 78.9 percent of bronchioalveolar (air sacs) lung cancers detected by LDCT represented an overdiagnosis.

“In the future, once there are better biomarkers and imaging techniques to predict which individuals with a diagnosis of lung cancer will have more or less aggressive disease, treatment options can be optimized, and a mass screening program can become more valuable,” the authors conclude.

This research was funded by grants from the National Institutes of Health.


Information from National Cancer Institute on CT Scans and Lung Cancer

What is computed tomography?

About Lung Cancer (MedlinePlus)

Lung cancer is one of the most common cancers in the world. It is a leading cause of cancer death in men and women in the United States. Cigarette smoking causes most lung cancers. The more cigarettes you smoke per day and the earlier you started smoking, the greater your risk of lung cancer. High levels of pollution, radiation and asbestos exposure may also increase risk.

Common symptoms of lung cancer include

  • A cough that doesn't go away and gets worse over time

  • Constant chest pain

  • Coughing up blood

  • Shortness of breath, wheezing, or hoarseness

  • Repeated problems with pneumonia or bronchitis

  • Swelling of the neck and face

  • Loss of appetite or weight loss

  • Fatigue

National Cancer Institute

Computed tomography (CT) is an imaging procedure that uses special x-ray equipment to create detailed pictures, or scans, of areas inside the body. It is also called computerized tomography and computerized axial tomography (CAT).

The term tomography comes from the Greek words tomos (a cut, a slice, or a section) and graphein (to write or record). Each picture created during a CT procedure shows the organs, bones, and other tissues in a thin “slice” of the body. The entire series of pictures produced in CT is like a loaf of sliced bread—you can look at each slice individually (2-dimensional pictures), or you can look at the whole loaf (a 3-dimensional picture). Computer programs are used to create both types of pictures.

Most modern CT machines take continuous pictures in a helical (or spiral) fashion rather than taking a series of pictures of individual slices of the body, as the original CT machines did. Helical CT has several advantages over older CT techniques: it is faster, produces better 3-D pictures of areas inside the body, and may detect small abnormalities better. The newest CT scanners, called multislice CT or multidetector CT scanners, allow more slices to be imaged in a shorter period of time.

In addition to its use in cancer, CT is widely used to help diagnose circulatory (blood) system diseases and conditions, such as coronary artery disease (atherosclerosis), blood vessel aneurysms, and blood clots; spinal conditions; kidney and bladder stones; abscesses; inflammatory diseases, such as ulcerative colitis and sinusitis; and injuries to the head, skeletal system, and internal organs. CT can be a life-saving tool for diagnosing illness and injury in both children and adults.

Lung cancer

The NCI-sponsored National Lung Screening Trial (NLST) showed that people aged 55 to 74 years with a history of heavy smoking are 20 percent less likely to die from lung cancer if they are screened with low-dose helical CT than if they are screened with standard chest x-rays. (Previous studies had shown that screening with standard chest x-rays does not reduce the death rate from lung cancer.) The estimated amount of radiation in a low-dose helical CT procedure is 1.5 mSv (1).

Despite the effectiveness of low-dose helical CT for lung cancer screening in heavy smokers, the NLST identified risks as well as benefits. For example, people screened with low-dose helical CT had a higher overall rate of false-positive results (that is, findings that appeared to be abnormal even though no cancer was present), a higher rate of false-positive results that led to an invasive procedure (such as bronchoscopy or biopsy), and a higher rate of serious complications from an invasive procedure than those screened with standard x-rays. NCI’s Patient and Physician Guide: National Lung Screening Trial provides more information on the benefits and harms.

The benefits of helical CT in screening for lung cancer may vary, depending on how similar someone is to the people who participated in the NLST. The benefits may also be greater for those with a higher lung cancer risk, and the harms may be more pronounced for those who have more medical problems (like heart or other lung disease), which could increase problems arising from biopsies and other surgery.

People who think that they have an increased risk of lung cancer and are interested in screening with low-dose helical CT should discuss the appropriateness and the benefits and risks of lung cancer screening with their doctors. They should also be aware that, because the technique is fairly new, some insurance plans do not currently cover it.

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