CT Scan Screening for Lung Cancer: Saving Lives at a Big Pricetag, and Who Should Pay?

The news about a major government study that found 20 percent fewer deaths in a group of heavy smokers who got annual CT scan screening for lung cancer has a few more statistics that are sobering for the rest of us who pay the price as a society for this screening.

The study enrolled 50,000 smokers and gave half of them CT scans and half regular chest X-rays, every year for three years.

All enrollees had to have had at least a thirty pack year history of smoking (that’s the same as one pack a day times thirty years, or two packs a day times fifteen years).

After three rounds of screening — a total of 75,000 CT scans in 25,000 patients — they found a total of 18,000 suspicious findings that needed follow-up — biopsies with long needles or some other kind of surgery. That was about a one-in-four incidence of suspicious findings per screen.

In those 25,000 people, eighty-eight lives were saved from lung cancer death. (The lung cancer deaths totaled 354 people in the CT group versus 442 in the control group of another 25,000 patients who got chest X-ray only for comparison.) That’s where the 20 percent number came from for the headlines.

So, bottom line: take 25,000 people, give them 75,000 CT scans, do further testing and surgery and more followup on 18,000, and save 88 lives.

Now, those are 88 very hideous deaths prevented. Lung cancer is one of the worst. But the delicate problem is that it’s also self-induced by smoking most of the time.

So who should pay for all this testing? That’s the kind of thing we need to have a national conversation over — not hysterical shouting about so-called “death panels” — but what can we really afford?

You can read the data from the government agency here.

And to see how the news media handle the story, contrast the AP story “CT scans modestly cut lung cancer deaths,” with the Washington Post (“significantly cut…”). Which is more accurate? It depends on how you focus your microscope. My vote is with the AP’s writer.

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