Testing smokers for lung cancer detects curable early-stage tumors, according to a new study. But the overall benefit remains unclear.
The story does a nice job of reporting on a new study of CT scan screening for lung cancer, including mentioning availability, novelty, the strength of the evidence, quantitative benefits, potential harms, costs, and independent sources.
One cautionary note: Although not technically part of our review criteria, the story does have elements of "treatment mongering." One example is that the story reports one man's experience with screening as part of the study. He had a tumor surgically removed and now claims "he's healthy." Anecdotal accounts like this are potentially biasing and overly-dramatic. There is no opposing perspective, such as a patient who experienced harms from screening, which would help balance this one person's rosy perspective. Another example is including one physician's perspective that he hopes lung cancer screening is included in routine healthcare, like mammography. Readers may not be aware that there is controversy surrounding widespread use of mammography screening and the statement assumes there is a survival advantage to lung cancer screening, which is not yet known.
But overall, the story is reported in a balanced, comprehensive way. It earns a five-star score.
The story tells readers the scans cost about $200-$400 and are generally not covered by insurance.
The benefits in this case are estimates of 10-year survival in those found to have lung cancer through screening, which is provided. Since there is no control group, there would be no way to provide an absolute risk reduction. But, the story does provide a 5-year chance of death estimate for those diagnosed conventionally, e.g. as a result of symptoms. This provides some relative comparison of what screening MIGHT offer, although it's not known for sure and readers are cautioned that direct comparisons are not possible.
The story mentions potential harms from screening, namely "serious health risks from examining and treating tumors that may not be harmful." The story could have been clearer about what some of these risks are (like undergoing unnecessary surgery with all of its risks and anxiety to the patient), but it appropriately mentions that screening may have harms, which is often overlooked.
The story tells readers that the latest study is uncontrolled, meaning direct comparisons cannot be made between groups of people who were screened and groups of people who were not screened. The article does describe this limitation to the study. The story could have been clearer that this is an observational study vs. a randomized controlled trial–which is the gold standard in research. Direct comparisons between groups will be difficult to make in the absence of a future randomized controlled trial.
The story tells readers that lung cancer is the leading cause of death from cancer in the U.S. The story does also describes the burden of lung cancer, providing estimates of 5-year survival without screening (estimates from the general population who were diagnosed as a result of symptoms). No obvious embellishments or overstatements.
The story obtains information from physicians not associated with the research who can provide a range of perspectives on what screening may or may not offer to provide balance.
The story provides some historical alternatives to CT screening for lung cancer (serial x-rays in the 1970s) and does indirectly describe the de facto alternative, that is, finding lung cancer as a result of symptoms. It does this by telling readers that lung cancer is rarely found curable in the absence of screening and providing estimates of chance of death within 5 years when diagnosed this way.
The story indirectly states that lung cancer screening is not widely available (e.g. "would widespread screening reduce cancer deaths?").
The story tells readers that interest in this technology increased in the late 1990s as a result of early work with lung cancer screening, providing some historical information about when lung cancer screening came onto the scene. The story also indirectly states that this is not widely available, implying that widespread lung cancer screening would be new, although a CT scan, the technology used for lung cancer screening, is not new.
The story is well-researched and uses input from many experts, which would not normally be contained within a press release.