Friday, September 2, 2022

Screenings for lung cancer could pose serious risks for patients, two expert physicians declare

False-positives from cat scans for lung cancer could do more harm than good.

At least that's the conclusion of two cardiologists at the University of California, San Francisco.

The two — Dr. Rita Redberg and Dr. Sanket Dhruva — published their view in a recent op-ed in the San Francisco Chronicle.

Their piece notes that while "more Americans are worried about cancer than Covid-19, according to a recent Gallup poll," the screenings often lead "to significant harm."

Dr. Rita Redberg
How? Redberg, who has served on the Medicare Payment Advisory Commission, and Dhruva contend that CT scans (computed tomography) "generally lead to more 'incidental findings,' without clinical significance, than to actual cancers being detected. And at least 20% of patients will receive false-positive findings." 

They go on to say that "at a minimum, this 'overdiagnosis' causes significant anxiety and stress. But it can also lead doctors to order more invasive procedures such as lung biopsies and sometimes surgery to remove part of the lung. Moreover, CT scans use X-ray radiation, which is associated with increased cancer risk."

On the other hand, cat scans might save a patient from lung cancer, which is now the leading cause of cancer death in the United States (130,000 people die from it each year).

The U.S. Preventive Services Task Force has recommended an annual CT scan for some patients with a heavy smoking history after shared decision-making — because it's been proven in clinical trials that it reduces the death rate when "performed on patients at high-risk — those age 50 to 74 who smoked about one pack per day for 30 years."

The Medicare Evidence Development and Coverage Advisory Committee, which Redberg has chaired and which is made up of independent experts, concluded, according to the op-ed, "there was not sufficient evidence that the benefits of a robust CT scan policy exceeded the harms."  

The op-ed further maintains "research shows that shared decision-making is rarely happening prior to CT scans, despite the Medicare requirement. When any conversation does occur, doctors underemphasize, or omit altogether, the risks — while overemphasizing the benefits. Medicare has failed to enforce its own shared decision-making requirement, meaning that hundreds of thousands of patients are agreeing to lung cancer screening scans without being fully informed of the risks and shortcomings of the test."

Dr. Sanket Dhruva
Redberg and Dhruva also contend that "published studies have shown that engagement in thoughtful shared decision-making about CT scans led about 40% of patients to decline lung cancer screening."

Doctors "owe it to patients," they conclude, "to equip them with the information and tools to make fully informed decisions."

More information about tests that can be risky can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

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