Lung cancer screening with chest CT: Pro/Con

A nice pro/con soundoff between Gerard Silvestri (con) and James Jett & David Midthun (pro) over whether lung cancer screening with chest CT should be national policy, in the wake of the positive findings of the National Lung Screening Trial.

Silvestri (of MUSC) argues that we don't have a handle on the harms of screening yet, and they may be substantial. His best points: The rate of surgical mortality in NLST was very low -- only 1%, compared to 3-5% for national data. He suggests this could be due to 2 reasons: first, the NLST surgeries were done at high-volume centers. Also, most of those undergoing surgery in NLST were younger than 70. Only 8% of subjects in NLST were 70 or older -- yet 70 is the average age at diagnosis of lung cancer. A national policy of lung cancer screening would result in a large number of cancer diagnoses in the elderly, many of whom would then be operated upon at low-volume centers. The increased surgical morbidity/mortality (above that observed in the NLST) could far overwhelm any benefit of screening.

Jett & Midthun (of National Jewish and Mayo, respectively) mostly play it straight down the middle, recapitulating the findings of the NLST and concluding that the benefits outweigh the risks, arguing "the 20% decrease in deaths is the single most dramatic decrease ever reported for deaths from lung cancer, with the possible exception of smoking cessation." They advocate directly that "[p]hysicians should offer computed tomography screening for lung cancer to patients who fit the high-risk profile defined in the NLST."

Silvestri G. Screening for Lung Cancer: It Works, But Does It Really Work? Ann Intern Med 2011;155(8):537-539. FREE FULL TEXT

Jett JR, Midthun DE. Screening for Lung Cancer: For Patients at Increased Risk for Lung Cancer, It Works. Ann Intern Med 2011;155(8):540-542. FREE FULL TEXT