A Medical Discussion on the Use of CT Scans to Screen for Lung Cancer November 24, 2006
Posted by rajkmd in Uncategorized.trackback
- This in relation to the following article.
- Views from three physicians
- Geoffrey Wittig, M.D., a family practice doctor in upstate New York, who says,
- This study has to be seen as a first crack at the problem, but by no means definitive. Lead-time bias is an obvious and huge problem by its very design. There is also no discussion of the risks and costs versus purported benefit. For instance, even accepting the absurdly optimistic CT cost of $150-200 per study, this translates to $8 billion per year just to scan every American smoker, ignoring the inevitable follow-on costs of biopsies and repeat studies. Then there is the estimated 1:1200 risk of future cancer per CT scan, which quickly becomes a very significant number when you’re scanning millions of smokers. Finally, there is no recognition of the opportunity cost of sinking that $8 billion per year into post-hoc screening, rather than zero-risk smoking cessation.
- George D. Bussey, M.D., the Chief Medical Officer of FirstHealth of the Carolinas, who says
- Re the issue of cost/benefit: Any CT operations folks out there that could address the question of the true marginal cost of adding this type of screening to existing CT capacity? If you have a scanner that has free time in off hours – what would it cost to bring in the staff and pay the other associated costs to run a screening clinic during “off hours?” Medicare and other insurers would have to agree to not force similar rates onto other CT services, but that approach might allow screening to be economially feasible.
- Dr. Michael LoCurcio , a Clinical Instructor at New York University School of Medicine, who says
- I very much agree with the comments made by Drs. Wittig and Bussey. In addition, any screening test will have a tendency to find disease that is relatively more benign when compared to historical data because historically the workups were driven by symptoms (”length bias”). This combined with the lead-time bias makes the comparison of this group’s mortality to estimated mortality very troublesome. When considering these biases, cost, and CT availability, I believe this screening modality should not be employed based on the evidence provided in this study. In the meantime we should continue to use the following tool for lung cancer screening: “Do you smoke” and “Are you exposed to smoke?”
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