tag:blogger.com,1999:blog-7323692122514281455.post7954069660906863415..comments2024-03-22T17:05:55.267-04:00Comments on MD Whistleblower: Can CAT Scans Prevent Lung Cancer? Smoke and MirrorsMichael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.comBlogger17125tag:blogger.com,1999:blog-7323692122514281455.post-52744198160623549592013-08-12T00:33:00.994-04:002013-08-12T00:33:00.994-04:00I've heard how CAT scans help but I am not sur...I've heard how CAT scans help but I am not sure how effective this scan could be. Anyhow, I am so excited to see more studies about it soon. Keep blogging!lung cancer alternative treatmentshttp://www.newhopemedicalcenter.com/lung-cancernoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-27194973741653841562010-11-18T09:31:49.665-05:002010-11-18T09:31:49.665-05:00@Joyce, I am truly sorry for your loss and am grat...@Joyce, I am truly sorry for your loss and am grateful for your comments. The reason I am antagonistic to the CAT scan screeing strategy is because I believe that this test performs very poorly, as I discussed in the post. I fear that if this strategy is widely implemented, that it will cause much more harm than healing. With regard to my views on the mammogram debacle, I have a blog post you may wish to read. http://bit.ly/656CwPMichael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-65325277366236022712010-11-18T03:59:59.043-05:002010-11-18T03:59:59.043-05:00Correction in above posting:
"mortality"...Correction in above posting:<br />"mortality" in first paragraph should read "survivial rates" (obviously)<br /><br /> - long day = tired advocateJoyce Neifertnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-6083120533798043652010-11-18T03:38:32.399-05:002010-11-18T03:38:32.399-05:00Dr. Kirsch,
Is it not true that even if all smokin...Dr. Kirsch,<br />Is it not true that even if all smoking ceased today, we would not see a significant decrease in lung cancer for decades? Do you propose that we simply sit on our hand (the other being in use for waggling the "shame on you" finger in the face of former smokers) and write off these casualties as collateral damage in the war against smoking? Pretty much has been the policy over the last 30 years and consequently, lung cancer mortality has remained stagnant while that of the other major cancers has skyrocketed. <br /><br />Perhaps you have overlooked the fact that the majority of diagnoses are in former smokers or those who never smoked. Ah yes, that's right, collateral casualties, since every person diagnosed with lung cancer is painted with the same tobacco stain resulting from decades of telling people to just stop smoking.<br /><br />And, by the way, just how IS that war on smoking going? Seems recent reports were that smoking appeared to be climbing once again after years of dropping. Guess those lung cancer deaths will just have to continue to mount. Heaven forbid we save a bunch, even those who wised up and quit. People should know better, right? <br /><br />From NCI's "Report of the Lung Cancer Progress Review Group" August 2001 - "Although the link to tobacco is the clearest etiologic relationship for a human cancer, the development of lung cancer in persons who have never smoked and in former smokers and the failure of the majority of heavy smokers to develop the disease are poorly understood. The complex inter-relationships among genetic, molecular, and other biologic processes in modulating the carcinogenic response to tobacco smoke need to be further explored." Forgive my poor, obviously non-MD, interpretation, but it would appear that there are a whole lot more factors than smoking we at which we ought to be looking.<br /><br />Catching lung cancer early is key to not only reducing the human cost of this disease, but also in changing the tide of public opinion regarding research funding. CT scans are the best chance we have for doing this NOW - TODAY. Some of the top lung cancer researchers in the country have long supported CT scans for lung cancer screening. It is interesting that strong criticism against it is usually accompanied by a position that we just need to get people to stop smoking. <br /><br />I second the comparison with mammograms. Did you post a similar response when the use of mammograms was challenged?<br /><br />One last comment - you see wasted $$$. Funny thing - I see only the face of my dead, non-smoking husband and eight other friends (most non-smokers), I lost to the disease in three years. That and the face of 10-year-old Gabby Wilson who has lung cancer. True this trial would not have been for them, but the potential of what this trial has produced has everything in the world to do with every lung cancer patient.Joyce Neifertnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-37772368834334106662010-11-12T17:33:15.133-05:002010-11-12T17:33:15.133-05:00Right on! Interesting point in comment above about...Right on! Interesting point in comment above about the difference between mammo and this study -- value-laden, is it not? Especially since the number needed to invite to save a cancer death for CT (~300) is nearly an order of magnitude lower than for mammo in 40-49 (~2,000). <br /><br />My take is here:<br />http://evimedgroup.blogspot.com/2010/11/more-thoughts-on-lung-cancer-screening.html<br />http://evimedgroup.blogspot.com/2010/11/ct-screening-for-lung-ca-epidemiology.htmlMarya Zilberberghttps://www.blogger.com/profile/16080475886113209344noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-38094223486659100262010-11-10T21:36:44.125-05:002010-11-10T21:36:44.125-05:00Is the difference between this report and the repo...Is the difference between this report and the report regarding women and mammograms from a year ago that those who contract lung cancer "deserve" it and those who contract breast cancer do not? Seems like I recall that even more women had to be screened and actually overtreated to save one life. And so many concerned parties came out of the woodwork on that one - the outcry was particularly loud from those who stood to lose substantial revenue if the new guidelines were embraced.<br /><br />Big difference in the response from the medical community on this issue than the mammogram issue, and yet the scenarios seem really similar. It seems that patients, in order to deserve compassion, must provide evidence of having lived a spotless life.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-75643649336064256452010-11-10T14:51:08.902-05:002010-11-10T14:51:08.902-05:00@Juliet, welcome to the blog! I was less impresse...@Juliet, welcome to the blog! I was less impressed with the data in the New York Times Annals of Medicne. Seems like the benefits are slim, and the pitfalls and expense are substantial. I look forward to reviewing your Alzheimer's post.Michael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-66292663277633898102010-11-10T13:11:19.715-05:002010-11-10T13:11:19.715-05:00Dr. Whistleblower Kirsh,
Interesting post--thanks....Dr. Whistleblower Kirsh,<br />Interesting post--thanks. I've been thinking a lot about the politics and industry of screening. Just wrote a post on KevinMD on the prospect of using the new biomarker test to screen for preclinical Alzheimer's: <br />http://www.kevinmd.com/blog/2010/11/questions-early-diagnosis-alzheimers-disease.html<br />One of the respondents to my blog appears to be highly invested in an industry that has a lot to gain from detecting Alzheimer's Disease early--think of all of those MRIs, PET's and neuropsych tests that might be done as a consequence, all with lack of a clear therapeutic that impacts clinical outcome. Now, think about lung CTs in smokers...actually, I was fairly impressed with the data that I read in the NY Times journal of medicine.Juliet Mavromatis, MDhttps://www.blogger.com/profile/15621812541697154967noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-67766891608292589782010-11-08T21:58:24.983-05:002010-11-08T21:58:24.983-05:00No it's not.
Keep up the nice writing.No it's not.<br /><br />Keep up the nice writing.B. RAD M.D.noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-58711401124471109062010-11-08T21:23:53.858-05:002010-11-08T21:23:53.858-05:00@B.Rad, I know you're a radiologist, but you&#...@B.Rad, I know you're a radiologist, but you're surname isn't really Rad, is it?Michael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-29861431959383155842010-11-08T21:02:20.351-05:002010-11-08T21:02:20.351-05:00Dr. Kirsch
It's surprising to me that this CT...Dr. Kirsch<br /><br />It's surprising to me that this CT screening is big news now. People have short memories. About a decade ago, CT screening, including whole body, was making headlines and imaging centers were popping up all over the place. Not so much anymore. You make excellent points many of which I agree. I can speak from the other side, being a Rad who's practiced for a while. Radiologists, if they see it, they most likely will report it. As I have seen more than one little incidental "ditsel" on a chest CT turn into a cancer over time, I don't know what size nodule should be ignored or reported. Management and follow up, of course should depend on the patient's risk for developing cancer. <br />Adverse effects of radiation exposure, I believe will become a big issue in years to come, which may bring on litigation such as we have seen in the tobacco industry. This, I realize, is another issue, but who should be the gatekeeper for this? Anyone working around xrays has to monitor his or her exposure. But the patient? Not that I,m aware of. Is 16 CT scans of the abdomen and pelvis in the last 23 month (real patient with pancreatitis) too much?B. RAD, M.D.noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-77486074390454831832010-11-08T16:30:38.006-05:002010-11-08T16:30:38.006-05:00@A.Bailey, point acknowledged
@Marilyn, agree with...@A.Bailey, point acknowledged<br />@Marilyn, agree with your fear of CAT scan mission creep.<br />@anonymous #1, welcome to my world<br />@Glenn, suggest you shred the article and discuss her smoking habit<br />@anonymous #2, is that all you could come up with?Michael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-87226657703403928292010-11-08T15:36:38.926-05:002010-11-08T15:36:38.926-05:00First of all, its been 'CT scan' for a few...First of all, its been 'CT scan' for a few decades. It would help if the author of the article new what he was talking about.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-71540166735331055792010-11-08T14:57:12.417-05:002010-11-08T14:57:12.417-05:00Excellent post Michael, and I agree with your posi...Excellent post Michael, and I agree with your position. It's appalling but not altogether surprising that a study like this--which can trigger billions of dollars in unnecessary testing--can receive so much attention in the press when the study has yet to be published in a peer-reviewed journal. <br /><br />What's a poor doctor to do when her next patient, a smoker, comes into her office with a copy of this article?Glenn Laffel, MD, PhDhttp://www.pizaazz.comnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-67113461185660040722010-11-07T13:31:04.250-05:002010-11-07T13:31:04.250-05:00Each cat scan will require prior auth from most in...Each cat scan will require prior auth from most insurance plans. Whenever a patient with hematuria gets a ct of the abd/pelvis and the lower lung fields yield a 2-3 mm nodule, the recommendation becomes do a CT q 3 months for a year, then q 4-6 months the next year, and then annually to demonstrate stability.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-36692294016858651862010-11-07T09:15:21.404-05:002010-11-07T09:15:21.404-05:00You make some very good points. Another thing tha...You make some very good points. Another thing that occurs to me is that this trial enrolled a select group of people who were at very high risk for developing lung cancer. If I recall correctly, they had to have smoked for 30 pack years, which is one pack a day for 30 years or 3 packs a day for 10 years, and so forth. What tends to happen in medical practice is that many doctors see results like this and will recommend that their patients start undergoing CT scans, even if they are not as high risk. Say, someone who has smoked for 20 pack years. In a person at lower risk, the benefit will be smaller, the cost will be the same, and the harm may be just as large, or nearly as large.Marilyn Mannhttp://marilynmann.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-73359915493242155062010-11-07T08:43:07.636-05:002010-11-07T08:43:07.636-05:00Yes, I'm quibbling, but no one asserts that CA...Yes, I'm quibbling, but no one asserts that CAT's can prevent lung cancer. Some assert that they can prevent, or reduce, lung cancer DEATHS. <br /><br />The best prevention is, of course, smoking cessation, but that is a different linguistic matter.A. Baileynoreply@blogger.com