TY - JOUR
T1 - Overstating the evidence for lung cancer screening
T2 - The International Early Lung Cancer Action Program (I-ELCAP) study
AU - Welch, H. Gilbert
AU - Woloshin, Steven
AU - Schwartz, Lisa M.
AU - Gordis, Leon
AU - Gøtzsche, Peter C.
AU - Harris, Russell
AU - Kramer, Barnett S.
AU - Ransohoff, David F.
PY - 2007/11/26
Y1 - 2007/11/26
N2 - 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.
AB - 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.
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U2 - 10.1001/archinte.167.21.2289
DO - 10.1001/archinte.167.21.2289
M3 - Review article
C2 - 18039986
AN - SCOPUS:36549011190
SN - 0003-9926
VL - 167
SP - 2289
EP - 2295
JO - Archives of internal medicine
JF - Archives of internal medicine
IS - 21
ER -