Healthy Skepticism Library item: 19031

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Welch HG, Woloshin S, Schwartz LM, Gordis L, Gøtzsche PC, Harris R, Kramer BS, Ransohoff DF.
Overstating the evidence for lung cancer screening: the International Early Lung Cancer Action Program (I-ELCAP) study.
Arch Intern Med 2007 26; 167:(21):2289-95
http://archinte.ama-assn.org/cgi/content/full/167/21/2289

Abstract:

Last year, the New England Journal of Medicine ran a lead article reporting that patients with lung cancer had a 10-year survival approaching 90% if detected by screening spiral computed tomography. The publication garnered considerable media attention, and some felt that its findings provided a persuasive case for the immediate initiation of lung cancer screening. We strongly disagree. In this article, we highlight 4 reasons why the publication does not make a persuasive case for screening: the study had no control group, it lacked an unbiased outcome measure, it did not consider what is already known about this topic from previous studies, and it did not address the harms of screening. We conclude with 2 fundamental principles that physicians should remember when thinking about screening: (1) survival is always prolonged by early detection, even when deaths are not delayed nor any lives saved, and (2) randomized trials are the only way to reliably determine whether screening does more good than harm.

Keywords:
Humans Lung/radiography* Lung Neoplasms/diagnosis Lung Neoplasms/mortality Lung Neoplasms/radiography* Mass Screening/methods Reproducibility of Results Sensitivity and Specificity Survival Rate Tomography, X-Ray Computed*