CT Scans for Lung Cancer Screening—Who Should Decide?

The Washington Post has a front page article today about the "debate" over using CT scans to detect the early stages of lung cancer. As the Post notes a recent study…

…found that screening certain heavy smokers and ex-smokers could slash their chances of dying from lung cancer. The finding was hailed as one of the most important advances in decades toward reducing the toll from the nation's leading cancer killer…. the scans could slash the death rate by a stunning 20 percent compared with old-fashioned chest X-rays.

So who might benefit? 

More than 222,000 Americans receive lung cancer diagnoses each year, and more than 157,000 die from the disease — more than from cancers of the breast, colon and prostate combined. Lung cancer has remained notoriously difficult to treat, in part because it is often diagnosed too late.

There are about 100 million current and former smokers in the United States, all of whom are at increased risk. Many more might be prone to the disease because of family history or exposure to substances such as radon and asbestos.

CT scans create three-dimensional images of the lungs, instead of the two-dimensional perspectives captured by chest X-rays. Scans are more likely to spot small tumors, boosting the chances of survival.

So what's the debate all about? Costs and side effects. First, the side effects. Almost any medical diagnostic test can turn up false positives which result in further interventions which themselves pose risks to patients. In this case, the Post observes:

The scans produced false alarms in about 40 percent of cases in the study. While screening saved 88 lives among the trial participants, 16 patients died from apparent complications from follow-up procedures, including six who did not have cancer.

Let's just say that that is not an insignificant rate of false positives and deleterious side effects. Of course, smart people in the government are now mulling over whether government health care programs should pay for the scans which also affects the decisions made by many private insurers. However, the Post does report the right answer: 

"We've always said it's a personal decision an individual needs to make," said Claudia Henschke, a professor of radiology at Mount Sinai Medical Center in New York.

Well, yes. Individuals worried about their risks should certainly be allowed to pay for the scans out-of-pocket. In addition, if we had a health insurance market that was not hamstrung by regulations and mandates, competitive private policies might well offer to cover such scans. Of course, people dependent on government health insurance will have to live (or die) by the decisions of those smart folks at the Centers for Medicare and Medicaid Services. 

Disclosure: After smoking for about ten years , I quit my 3-pack a day habit 25 years ago. I might want to have a scan sometime in the future.