Too Many People Have Lung Cancer Surgery When They Don’t Have Lung Cancer

No one would ever describe “surgery” as a walk in the park, but if being operated on resolves a problem or makes it less bad, it can be worth the risk, trouble and discomfort. But what if you undergo surgery to resolve a problem you never had?

According to a preliminary paper presented earlier this month at the annual meeting of the American Association for Cancer Research, nearly 1 in 10 people having this surgery in fact have a benign disease; that is, they had surgery unnecessarily. About 2 in 100 of the patients with the benign condition died in the hospital after the lung surgery.

A couple of factors contribute to this troubling and wasteful medical “care.” One big one is a screening test that seems to indicate the presence of cancer, but in fact is a false positive. Last year we wrote about the abundance of this kind of misdiagnosis in lung cancer screenings.

The study was reported on MedPageToday. Although the average rate of benign lung disease is high, rates vary widely from state to state-Vermont registered the lowest (1.3%), and Hawaii had the highest (25%). And women were somewhat more likely to have the benign condition than men-9.8% to 8.5%.

The study was inspired by the National Lung Screening Test, which showed in 2010 that CT scans were superior to chest X-rays to reduce deaths from lung cancer, and which boosted the profile of the diagnostic scans.

But nearly 1 in 4 lung surgeries in that study resulted in a diagnosis of benign disease.

The new study relied on data from a single year for more than 25,000 patients who had surgery for known or suspected lung cancer. It examined the geographical variations for patterns that might inform a best-practice approach for successful screenings-those that find cancers without unacceptable rates of false-positives.

One reason there’s so much variation among the different states might be simply a matter of local standards of care. Patients in some places go into surgery much faster after a suspicious test than in other places. Speed, suggested the authors, might cause more errors.

Some places have higher incidents of certain disorders that might complicate things. One, for example, is histoplasmosis, a fungal infection found in humid areas. It can cause an imaging result that looks like it might be lung cancer.

Now, the researchers are studying data from several years to see if the rate of benign disease changes over a longer period of time. They’re also focusing on associations between benign disease rates and the prevalence of disease-causing fungi by region.

They’re trying to tease out the difference between the cultural practices of certain areas that would lead to higher rates of benign disease versus actual differences in the incidence of it from place to place.

Once you can tell the difference between a false-positive caused by hasty or misinformed medical practices from those caused by, say, an environmental organism, you can hone your screening recommendations to people who would benefit most.

Dr. Louis Weiner, who was not involved in the study, is affiliated with Lombardi Comprehensive Cancer Center at Georgetown University. His analysis? “This is information and information doesn’t become powerful until you can convert it into knowledge.”

If your doctor prescribes a screening test, ask:

• What are the possible benefits?
• What are the possible harms?
• How often do harms occur?
• Are there alternative tests?