Friday, January 20, 2012
Can a $99 spiral CT scan detect curable lung cancer?
A hundred bucks doesn't buy much these days. A crisp Ben Franklin can be exchanged for:
--50 Big Macs
--a Broadway show ticket
--a night in a New York City hotel (just joking)
--a college textbook (paperback)
Your life? Yes, five crumpled Andy Jacksons can save your life, as was reported earlier this year in a front page article in The Plain Dealer, Cleveland's only daily newspaper. University Hospitals is now offering a $99 spiral computed tomography (CT scans) of the chest in individuals who are at increased risk of developing lung cancer. The rationale is that if cancers can be detected early, then the cure rate for surgical removal is very high.
Gary Schwitzer, medical blogger and press watchdog, tries to bring some balance to the distorted media coverage of CT lung cancer reportage.
The test is not covered by insurance, so consumers will have to hand over 10 Al Hamiltons to get in the door.
I'm a deep skeptic of this effort, and predict that with some more time, the promised benefits will prove to have been exaggerated and the drawbacks will become clear. Although one national study suggested that spiral CT scanning was effective, one study shouldn't change the course of medical practice. If you've been reading medical journals for a while, as I have, you realize that today's breakthrough may break apart tomorrow. Let's see what future studies on screening for lung cancer with spiral CT scans conclude. I predict growing medical dissent on this issue.
Although I am uncertain about the early promise of saving lives, I am quite certain that the scans will uncover zillions of "abnormalities." Undoubtedly, folks will be discovered with benign, insignificant lung lesions, which physicians call incidentalomas. This term refers to abnormalities found by radiologic tests that have no medical significance, but inexorably generate a cascade of medical testing. Every physician can attest to this phenomenon.
Most lesions that spiral CT scans discover will be incidentalomas. Of course, unless there exists a prior CT scan that would prove that the lesion was present years ago and is unchanged, then the incidentaloma will be described as suspicious. So, although most of the abnormalities are benign, they will have a malignant effect on patients and their families. Here is what these folks have to look forward to:
--anxiety that cancer is present
--diminishment of quality of life
--referral to a pulmonary specialist for more fun and games
--prospect of periodic CT scans for 2 years to verify the lesion is stable
--consideration of a biopsy of the lesion (Ouch!)
--consideration of surgery to remove the lesion (Mega-ouch!)
--medical complications from biopsy or surgery
--waste of health care dollars
Although The Plain Dealer's piece was gushing, there is another side to the story. Is University Hospital pursuing this for medical or for marketing reasons? Will other area hospitals start hawking their own screening CT scans so as not to be left out? Will a bidding war begin driving prices down? This sounds like it could become a 2 a.m. TV telemarketing pitch.
"You won't pay $250, or even $200. No, you won't pay $150. For just five easy payments of $19.99, you get a state-of-the-art spiral CT scan. And, if you order in the next 10 minutes, we will include a set of Japanese steak knives guaranteed for life. These knives alone are a $200 value. But wait, there's more. If you promise to tell a friend about this special TV offer, we will include a cigarette lighter that opens up to form an ashtray. No smoker should be without one. And, if for any reason, you are not completely satisfied with your scan, we will return the full purchase price, minus a shipping and handling charge, no questions asked. Return the knives, but keep the lighter/ashtray as our gift."
My view? I recommend that smokers find a better use for 20 Abe Lincolns than a spiral CT scan. My suggestion? See a Broadway show.
This post by Michael Kirsch, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
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