Below is a cut and paste from an article from Monday 8/5 NY Times:
Pity the poor patient who tries to make sense of federal advisory committee reports that appear headed in opposite directions. For at least three decades, Americans have been told that it’s best to detect cancers early, when they are theoretically most curable. So it was not all that surprising when an authoritative advisory group recommended that very heavy smokers get an annual CT scan to check for early signs of lung cancer. It was much more surprising, however, when a separate group of experts suggested that for several cancers — including potential lung cancers — early scans are detecting too many abnormalities that aren’t dangerous and should not be treated.
Oddly enough, both groups, which issued their recommendations last Monday, may be right.
The recommendations on smokers came from the United States Preventive Services Task Force, independent experts who serve as the federal government’s foremost authority on screening procedures. Screening with chest X-rays, long the standard approach, seldom catches a tumor early enough for surgeons to save a life. In 2010, however, a large clinical trial found that low-dose CT scans, which detect much smaller tumors, could reduce mortality by 16 percent among patients at the highest risk of lung cancer because of their age and smoking history.
That led several prominent medical groups to recommend such screening in high-risk current and former smokers. Now, based primarily on that same study, the Preventive Services Task Force, the final arbiter, has recommended that people ages 55 to 79 who have smoked a pack of cigarettes a day for 30 years or two packs a day for 15 years or the equivalent get annual CT scans. That includes former smokers who have quit within the past 15 years. It estimates that such screening could save 20,000 lives a year, among the 160,000 Americans who die each year of lung cancer.
The task force said it had “moderate certainty” that the screening would produce a “moderate net benefit” in these high-risk smokers but did not know whether the same would be true in lower-risk patients. It gave lung cancer screening a grade of B, on a par with mammography. Under the Affordable Care Act, that would require Medicare and private insurers to pay for the screening tests without any cost to consumers.
Meanwhile, three members of a working group advising the National Cancer Institute, the federal government’s pre-eminent supporter of cancer research, suggested “over diagnosis” — the detection of tumors that would not cause illness or death if left unattended — is common in cases of breast, lung, prostate and thyroid cancer. Such over diagnosis often leads to further tests and biopsies to determine if a tiny tumor looks dangerous, followed by surgery, radiation or chemotherapy to eliminate an abnormality that would never have caused illness. In such cases, the cure is worse than the disease it is trying to prevent.
The group said that, ideally, screening tests should focus on tumors that will cause harm and are more likely to be cured if detected early. But that can’t be done until scientists find better ways to identify which lesions are truly worrisome. The group also proposed renaming some conditions to exclude the word cancer so that patients might be less frightened and less apt to press for unneeded tests and treatments. For instance, the tiny breast tumors called ductal carcinoma in situ would be renamed to exclude the word carcinoma.
Recommendations from both these groups come with uncertainties and unanswered questions. This will put the burden on patients, in consultation with their doctors, to decide whether to get early screening for various cancers and what to do based on the findings.
http://www.nytimes.com/2013/08/05/opinion/mixed-blessings.html?nl=todaysheadlines&emc=edit_th_20130805
RickyD