by Carol Ko
, Staff Writer | September 05, 2013
From the September 2013 issue of HealthCare Business News magazine
A much-discussed study released by the National Cancer Institute called the National Lung Screening Trial (NLST) demonstrated that using low-dose CT instead of traditional X-ray resulted in a 20 percent decrease in mortality. “A study like this doesn’t happen too often these days,” says Mochon.
What’s more, the figure also doesn’t necessarily get at the true value of the screening, since the NLST advisory board recommended ending the study—the most expensive screening study ever proposed—after it reached a “statistically significant” 20 percent decrease in mortality.
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This is a potential point of controversy among physicians who feel that the study was stopped too early. “It could have been extended for another five years to look at the overall effect on disease-specific mortality. If this had been done, 20 percent might actually be a significant underestimation,” says Dr. David Naidich, professor of radiology (specializing in chest radiology) at NYU Langone Medical Center.
The modality shows particular promise for detecting early stage lung cancer before patients even develop symptoms. Most lung cancers are found when the tumor is relatively large and the disease has already progressed too far for treatment. By catching the disease early with CT scans, patients could avoid prolonged chemotherapy, surgeries and other treatment, potentially reducing the overall cost of care.
Recently, a first-of-its-kind actuarial study in Health Affairs that examined the economics of CT lung cancer screening seemed to confirm that these screenings had a clear cost benefit. CT lung cancer scans would cost less per life-year-saved than cervical and breast cancer screening, according to the study.
Too much of a good thing?
On the other hand, CT screening for lung cancer is not without its critics. For one, some people may question the fairness of putting public dollars toward treating a disease whose cause is widely known. “Many people think smokers brought it on themselves and don’t want to invest in preventative screening programs,” says Bruce Pyenson, co-author of the actuarial study in Health Affairs and principal and consulting actuary at Milliman.
Furthermore, some experts still say that the benefits of the screening may not outweigh its potential drawbacks. This isn’t a criticism confined to just lung cancer — in recent years, breast and ovarian cancer screenings have received flak from critics who allege that the false positives, overdiagnosis and overtreatment caused by screening actually result in greater harm than good, on balance.