Screening and the American Cancer Society

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This controversy has been said to pit the "snails" against the "evangelists", the snails being those who are unwilling to commit to a massive screening effort until tight statistical proof of benefit is obtained, and the evangelists being those who feel that it is imperative to screen now on the basis of the strong suggestive evidence available today.

The American Cancer Society and many other certifying organizations do not recommend screening for lung cancer for the following reasons.

1. There has never been a controlled randomized study that shows that mortality is reduced in a screened population.
2. Although screened populations show a higher five year survival, this may be due to legnth time and other types of bias.
3. Screening for lung cancer has a low sensitivity, i.e.screening misses many lung cancers.
4. Screening for lung cancer has a low specificity, i.e. many of the patients picked up in the screen will turn out to have other diseases than lung cancer and they will get expensive tests and possibly even an unnecessary operation with it's attendent morbidity and mortality.

It is my position that, although all of the above reasons are true to a greater or lesser degree, all are essentially minor deterents. The basic reason that the problem exists in the first place, is that our society has done a very poor job in the past, in trying to get rid of the etiologic factor that causes lung cancer. No ethical researcher is willing to do a true double blind study in which one group of smokers gets no screening. The arguments about the various biases are really quite trivial to anyone who has a large experience with lung cancer. The indolent, slow growing lung cancer or the lung cancer that would have gone away by itself if left alone, postulated by those opposed to screening, rarely exist in the real world. Finally, all of these arguments ring hollow when compared with the awful carnage that is occuring because we are not screening. One hundred and fifty thousand human lives weighed against an expense of a few billion dollars and some unnecessary tests and operations tips the balance in favor of screening quite convincingly in my opinion.

Now that CT scans can be obtained very rapidly with new equipment, cost per exam should decrease and perhaps CT screening will provide the improved sensitivity and specificity needed for high quality screening.

Finally, laws should be legislated to force the tobacco companies to pay for the expense of screening for the disease that they have and will cause.. For information on recent screening studies in Japan

The official "snail" position is stated at this site.

MASS SCREENING FOR LUNG CANCER

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