Study questions cost-effectiveness of new lung cancer screening
LINDSEY TANNER, Canadian Press
Tuesday, January 14, 2003
CHICAGO (AP) - A new type of CT scan promoted as a means of detecting lung cancer at its earliest stages is unproven, can lead to invasive testing and would probably not be cost-effective as a widespread screening tool, researchers say.
The so-called spiral CT scans involve scanners that view the lungs and surrounding tissue at various angles and can spot pea-sized growths. The scans are heavily promoted over the Internet and on U.S. television.
But the new tests cost hundreds of dollars, are not covered by insurance in the U.S., and may lead to more diagnostic procedures such as surgery. Until solid data shows the tests are beneficial, most people may want to hold off on getting the tests, researchers said in an analysis that appears in Wednesday's Journal of the American Medical Association.
The scans are being evaluated in a recently launched National Cancer Institute study comparing them with standard chest X-rays. But the results are not expected for several years.
"These scans aren't risk-free," said Dr. Parthiv Mahadevia, who led the JAMA study at Johns Hopkins Medical Institutions. "There is a downside to this, including high costs and possible harm to individuals who may unnecessarily get invasive procedures if the scan detects a benign lung nodule."
Lung cancer, often diagnosed at advanced stages when it is incurable, has an average five-year survival rate of only 15 per cent.
To analyse the cost-effectiveness of spiral CT scans, the researchers used a computer model of 100,000 hypothetical heavy smokers age 60 and older, based on data on real patients.
Using the model, the researchers calculated there would be 4,168 lung cancer deaths per 100,000 patients who did not get screened, versus 3,615 lung cancer deaths among those who were screened.
While the screening reduced deaths by 13 per cent, there were also 1,186 invasive tests or operations for non-cancerous lesions per 100,000 smokers screened. That rate would probably be higher if low-risk people such as nonsmokers were screened, the researchers said.
The researchers estimated it would cost $116,300 US to save one year of life. That is much more expensive than standard lung cancer tests.
The researchers noted that an estimated 50 million Americans age 45 to 75 are current or former smokers. It would cost an estimated $115 billion if just half of them got the CT tests annually, including costs associated with false-positive results, the researchers said.
Dr. Kay Vydareny, an Emory University radiologist who is participating in the NCI study, said her husband underwent a similar test used to detect colon cancer last year. No colon cancer was found, but suspicious nodules in his lungs and liver showed up on his scan. For more than a week, he thought he had advanced cancer - until a $48,000 work-up including a liver biopsy and chest surgery showed the nodules were harmless.
Vydareny said patients who want the tests should know that "it's very unlikely you're going to be told you have something that looks like cancer - or you are perfectly normal." She said it is more likely that the results will be inconclusive and more tests will be needed.
© Copyright 2003 The Canadian Press