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CT scan virtues for detecting lung cancer could lead to vices

A recent study showing the virtues of CT scans in detecting lung cancer in heavy smokers is prompting a public relations blitz from hospitals and screening centers who provide the scans. It’s also drawing concern from radiologists and the American Cancer Society, who worry that the promotions will entice patients at low risk of developing […]

A recent study showing the virtues of CT scans in detecting lung cancer in heavy smokers is prompting a public relations blitz from hospitals and screening centers who provide the scans.

It’s also drawing concern from radiologists and the American Cancer Society, who worry that the promotions will entice patients at low risk of developing lung cancer, leading to unnecessary biopsies or even partial lung removal.

The National Cancer Institute released study data Nov. 4 detailing a 20 percent reduction in the risk of death from lung cancer among current and former heavy smokers. The scans saved the life of one person for every 300 subjects scanned.

Scan providers were quick to jump on the news, promoting their businesses with advertising and new websites extolling the preventive power of CT scans. That prompted a PR counter-offensive from Dr. Otis Brawley, chief medical officer of the American Cancer Society, who told the New York Times that he and colleagues are “very frightened some people are going to be harmed because of this.”

“We really need to weigh the harms associated with screening,” Brawley told the newspaper. “The scientific community still needs to digest this. To take a trial that involves people at high risk for lung cancer and to extrapolate it and say it’s good for people with intermediate or low risk is not appropriate.

“It was sort of ominous to be working Sunday evening in my home office and this thing comes on the radio,” he said. “A lot of people run out when there is a new announcement and get the new test.”

“The aggregate harms to all the people’s lives who are not saved have to be taken into account,” Dr. Peter Bach, a pulmonologist at Memorial Sloan-Kettering Cancer Center in New York, told the Times. “Even in these highly controlled settings, about 1 percent of the people had surgery or a part of their lung removed for something they thought was cancer and it wasn’t.”

It’s been a big month for lung cancer, and not just because November is National Lung Cancer Awareness Month. Last week the Food & Drug Administration issued recommendations for CT scan equipment makers aimed at reducing the risk of overexposure, after investigating reports of overexposure during brain scans. The FDA probe found at least 385 patients who were exposed to unsafe levels from CT brain scans. Many of the victims were undergoing the test to confirm the presence of a stroke at five hospitals in California and another in Alabama.

In September, 12 patients treated at Alabama’s Huntsville Hospital using CT scanners made by General Electric’s (NYSE:GE) healthcare unit filed a lawsuit against the company for receiving excess radiation from the devices. The plaintiffs said the scanners caused brain damage, memory loss, baldness and other symptoms, according to the suit.

Use of CT and MRI scans almost tripled in the 10 years between 1998 and 2007, according to a study by the Journal of the American Medical Assn., meaning many more patients were exposed to higher levels of radiation. Researchers from Johns Hopkins University in Baltimore studied data on emergency room visits from 1998 to 2007, looking for evidence that “excessive use of medical imaging increases healthcare costs and exposure to ionizing radiation (a potential carcinogen) without yielding significant benefits to all patients,” according to the JAMA report. They found that, while the use of the scans went from 6 percent of ER visits in 1998 to 17 percent in 2008, there was no corresponding increase in the diagnosis of life-threatening conditions or hospital admissions.

The Massachusetts Medical Devices Journal is the online journal of the medical devices industry in the Commonwealth and New England, providing day-to-day coverage of the devices that save lives, the people behind them, and the burgeoning trends and developments within the industry.

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