The New Health Dialogue

^{Photo via Derek K. Miller on Flickr, under a Creative Commons license.}

Two weeks ago, a new study funded by the National Cancer Institute of the NIH released its findings: low-dose CT scanning to screen longtime smokers for lung cancer can reduce mortality by 20 percent relative to x-ray screening.*  That might seem like great news—if not for the reaction from hospitals and medical providers, which are using the study as an excuse to market CT scans.

The study received broad coverage when it was released, which isn't surprising—a 20 percent reduction in deaths among smokers is a pretty important result. However, the patients in the study were all longtime smokers between the ages of 55 and 74, with more than 30 pack years (meaning they smoked an average of a pack a day for 30 years, or two packs a day for 15 years—over 200,000 cigarettes in all). Since the study was so narrowly focused, it didn't establish that CT screening offered any benefit to younger smokers or those who hadn't smoked as long.

This hasn't discouraged hospital marketing departments and outpatient clinics.  Kaiser Health News reported that hospitals were offering discounted CT scans (less than $100, on a scan that normally costs up to $1000), and advertizing in newspapers and on billboards with no mention of the fact that the study didn't look at people who weren't heavy smokers. The advertising message: Come one, come all.

Even heavy smokers would do well to think carefully before signing up for a CT scan.  Over ninety percent of potential cancers found by both types of scans were false positives—meaning patients had to undergo potentially costly, painful, and risky follow-up testing and treatment for lumps that weren't even cancer. During the study, although 88 lives were saved, 16 people died from complications during treatment. Six of them didn't have cancer at all.

It's also possible that the extra cancers found by the CT scan would never have become harmful. That's hard to imagine, but there's growing evidence that not all cancers are destined to become dangerous. 

As for promotional pricing and billboards advertizing CT scans, the goal is to drive patient traffic to profitable scanning and cancer departments at hospitals, regardless of whether or not it will actually save patients' lives. Rather than keeping people healthy, these scans could put patients at risk of unnecessary stress, fear, and even death.

We'll think twice before signing up for a discount CT scan.

The finding of benefit relative to x-ray screening is less striking when you note that there's no evidence that it reduces mortality, and no medical body recommends regular screening for people without symptoms.