Page 13 - Delaware Medical Journal - March/April 2020
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EDITORIAL
assigned to periodic low-dose CT screening or no screening. At a follow- up of 10 years, lung cancer mortality was lower in the screening group than
in the control group; both among men, lowered by 24%, and among women, lowered by 33%. The authors estimated that approximately 60 deaths from lung cancer were prevented as a result of four offered rounds of screening in 7,900 participants. The Dutch-Belgium lung- cancer screening trial now adds to the that low-dose CT screening reduces lung cancer mortality.
Despite these two well-designed, randomized clinical trials, which are
the gold standard in cancer care and prevention, there are still naysayers. But there is good news. Despite the naysayers, the Delaware Cancer Advisory Council and Consortium, along with all cancer centers in the state of Delaware, initiated in April 2015 a statewide lung-cancer screening program with low-dose CT.
We certainly understand the naysayers’ points of objection to lung cancer screening. One point of emphasis is
the concept of overdiagnosis or a so- called cancer diagnosis that would not cause symptoms or death. However, overdiagnosis occurs with any screening has to make a determination of the risk mortality far outweighs the risk of overdiagnosis.
CT scanning of the lungs can also discover other “abnormalities,” known as require further evaluation, which can add to cost, patient anxiety, and procedural complications. Certainly, individuals who are participating in any lung-cancer
screening program are at risk for other
of past smoking or active smoking. Several patients may also have other co-morbid conditions, leading to other outweighs the risk of discovering an incidentaloma.
We agree with Duffy and Field7 in their editorial in the New England Journal of Medicine commenting on the Dutch-
CONTRIBUTORS
■ NICHOLAS J. PETRELLI, MD
Bank of America Endowed Medical Director Helen F. Graham Cancer Center
& Research Institute
ChristianaCare, Newark, Delaware
■ STEPHEN GRUBBS, MD
Vice President, Clinical Affairs Department American Society of Clinical Oncology Previous Medical Oncologist, Helen F. Graham Cancer Center & Research Institute
Belgium lung-cancer screening trial:
with the results of this trial and those low-dose CT screening for lung cancer is our job as physicians and investigators
is no longer to argue about whether low-dose CT screening for lung cancer
is effective — it is! Our job in the era of genomics is to identify those individuals for whom lung cancer screening will not only be acceptable, but also cost-effective. We hope the naysayers agree.
■ JAMES SPELLMAN, MD
Chief of Surgical Oncology Tunnel Cancer Center
Beebe Hospital, Lewes, Delaware
■ HEATHER BITNER-FAGAN, MD
Department of Family and Community Medicine ChristianaCare, Newark, Delaware
■ ALBERT RIZZO, MD
Chief Medical Officer
American Lung Association Pulmonary Staff Physician ChristianaCare, Newark, Delaware
All authors are members of the Delaware Cancer Consortium/Delaware Cancer Advisory Council
REFERENCES
1. The National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 365: 395-409, 2011.
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin, 70:7-30, 2020.
3. The National Lung Screening Trial Research Team. Lung cancer incidence and mortality with extended follow-up in the National Lung Screening Trial. J Thorac Oncol, 14:1732-42, 2019.
4. de Koning HJ, Meza R, Plevritis SK, et al. Benefits and harms of computed tomography lung-cancer screening strategies: a comparative modeling study for the U.S. Preventive Services Task Force. Ann Intern Med, 160: 311-20, 2014.
5. Humphrey LL, Deffelbach M, Pappas M, et al. Screening for lung cancer with low-dose computed tomography: a systematic review to update the U.S. Preventive Services Task Force recommendation. Ann Intern Med, 159: 411-20, 2013.
6. de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med. 382;6;503-513,2020.
7. Duffy, S., Field, J. Mortality reduction with low-dose CT screening for lung cancer. N Engl J Med. 382;6;572-573,2020.
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