Effective lung cancer screening is possibleBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g363 (Published 21 January 2014) Cite this as: BMJ 2014;348:g363
- David R Baldwin, consultant respiratory physician1
McCartney makes a case against high profile TV programmes that give an unbalanced view of screening.1 As a lung cancer screening expert interviewed in one such programme, I agree.
Those working in lung cancer research know how little priority is given to this disease that kills more people than breast and bowel cancer combined. McCartney’s article is no exception, with only one accurate but completely inadequate sentence devoted to lung cancer screening. She says that the programme “presented lung cancer screening rosily” without discussing “caveats or uncertainties about benefits and harms, including false positive findings and radiation risks.” This area is well researched, except for psychological harms, where data are limited. Large randomised controlled trials have reported the frequency of repeat imaging and minimally invasive procedures, and the rate of resection of benign disease. These are within acceptable levels and provide overall benefit. The US National Lung Screening Trial was stopped one year early because mortality reduction had reached the prespecified stop criteria (20%). Those screened had three annual low dose computed tomograms; controls had chest radiography. Many younger patients were at relatively low risk of lung cancer, and risk would increase as they aged during the non-screened follow-up. Thus, these results are striking and worthy of mention.
McCartney also criticises the programme for failing to say the US Preventive Services Taskforce had not recommended screening for prostate cancer, but she did not mention that it did recommend lung cancer screening and extended the age range for screening from 55-74 to 55-80 years. Problems for lung cancer screening in the UK remain, but effective screening should be possible by refining selection, managing findings more efficiently, and using modern low dose imaging. Evidence suggests that this would substantially reduce mortality from lung cancer. We need clear and understandable information about potential benefits and harms, so that people can make informed choices.
Cite this as: BMJ 2014;348:g363
Competing interests: I was interviewed for one of the programmes in question (Too Late To Save Your Life) and was not portrayed in a very good light (actually a reverse conflict)
Full response at: www.bmj.com/content/347/bmj.f7643/rr/680748.