Overstating the evidence for lung cancer screening: the International Early Lung Cancer Action Program (I-ELCAP) study.
Last year, the New England Journal of Medicine ran a lead article reporting that patients with lung cancer had a 10-year survival approaching 90% if detected by screening spiral computed tomography. The publication garnered considerable media attention, and some felt that its findings provided a persuasive case for the immediate initiation of lung cancer screening. We strongly disagree. In this article, we highlight 4 reasons why the publication does not make a persuasive case for screening: the study had no control group, it lacked an unbiased outcome measure, it did not consider what is already known about this topic from previous studies, and it did not address the harms of screening. We conclude with 2 fundamental principles that physicians should remember when thinking about screening: (1) survival is always prolonged by early detection, even when deaths are not delayed nor any lives saved, and (2) randomized trials are the only way to reliably determine whether screening does more good than harm.
VA Outcomes Group, White River Junction VA Medical Center, 215 N Main St, VA Outcomes Group, 11B, White River Junction, VT 05009, USA.
H Gilbert
HG
Welch
Steven
S
Woloshin
Lisa M
LM
Schwartz
Leon
L
Gordis
Peter C
PC
Gøtzsche
Russell
R
Harris
Barnett S
BS
Kramer
David F
DF
Ransohoff
D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality; D008403:Mass Screening / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014057:Tomography, X-Ray Computed