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.

Actress pushes women's mental, physical health

Angelina Jolie promoting care for breast cancer patients, especially through loved ones, docs, research

More and more, Academy Award-winning actress Angelina Jolie is becoming known for her work outside Tinseltown.

Such as promoting caregiving for breast cancer patients — not only in regard to the care of loved ones but other aspects pertaining to "mental and emotional health, and physical safety."

Angelina Jolie

In a piece she wrote for a recent edition of Time magazine, Jolie, who's gained even more fame as a special envoy of the U.N. High Commissioner for Refugees, explains that "care is not just about medical treatments. It's also about the safety, dignity and support afforded to women, whether they're battling cancer or trying to manage other stressful situations."

Far too often, her column indicates, "they're not given nearly enough."

Jolie had a prophylactic double mastectomy in 2013 — plus surgery two years afterward to remove her ovaries and fallopian tubes — because she'd learned through a genetic test that she carried a mutation of the BRCA1 gene, which sharply increased her chances of developing breast and ovarian cancer.

The surgeries reduced but didn't eliminate those chances. With the operations, she writes, she had an estimated risk of 87 percent of getting breast cancer, 50 percent of ovarian.

Without the mutation, women typically have a 13 percent risk of breast cancer.

But Jolie, a contributing editor of Time, insists that without proper care, a female patient can fall apart not only because of risks of disease like cancer but "because of other pressures in her life that receive no attention at all…her family situation, her safety and whether she is carrying stress that is undermining her health and making her days much more difficult."

It should not take "someone getting sick to realize that faring for them and not harming them is necessary," she insists.

The now 44-year-old Jolie, who'd lost both mother and grandmother to breast cancer before their late 50s, adds that although there's been rapid progress in technology and science since her surgeries that can help "more people survive in the future and [be] able to live better lives during their illness," there's still "no reliable screening test for ovarian or prostate cancer…and no effective treatment for the most aggressive forms of breast cancer, known as triple negative cancers."

The actress, daughter of actor Jon Voight, while maintaining that care and support of loved ones is the most important factor in women's ability to cope with cancer and to face even the possibility of the disease, cites other related problems that plague modern females — post-traumatic stress disorder, for example, "anxiety, psychological distress, sexual violence and domestic violence."

And then, she writes, there's "poor mental health" stemming from "discrimination, overwork, poverty, malnutrition, low social status and unremitting responsibility for the care of others."

Care for patients is an integral part of "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.