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A federal task force is planning to urge millions of smokers and former smokers to get an annual test that looks for early signs of lung cancer. The proposal was released today by the Annals of Internal Medicine. The panel is convinced that the test, a computerized X-ray scan, will save tens of thousands of lives. But as we hear from NPR's Richard Knox, the screening has some important downsides.
RICHARD KNOX, BYLINE: The U.S. Preventive Services Task Force says its proposed recommendation will prevent 20,000 Americans a year from dying of lung cancer. Dr. Michael LeFevre, a vice chairman of the panel, acknowledges that's only about 15 percent of the 160,000 people who die of the dread disease every year.
DR. MICHAEL LEFEVRE: But a small proportion of a big number is still a big number. And 20,000 lives is a lot of people.
KNOX: Nearly 90 million Americans are smokers or former smokers. The task force is targeting 7 million of them for annual CAT scans. They're people between 55 and 79 who've smoked the equivalent of a pack of cigarettes a day for 30 years. If they've quit, it needs to have been within the past 15 years to qualify. The task force gives lung cancer screening a grade of B. That puts it on par with mammography in terms of effectiveness. In fact, LeFevre says it's better.
LEFEVRE: We can, in fact, screen fewer people and avoid more deaths than we can with mammography.
KNOX: It takes 320 lung scans of high-risk people to prevent one lung cancer death. But it takes 900 scans of women past 50 to prevent one death from breast cancer. By law, a task force grade of A or B obligates Medicare and private insurers to cover a screening test with no cost to consumers. Besides mammography, there are only two other approved cancer screening tests: colonoscopy and pap smears. Both of those have an A rating.
But LeFevre cautions that lung cancer is by far the most complicated screening problem. A single scan can't distinguish between something that's cancer and something that's not. It takes repeated scans and sometimes biopsies.
LEFEVRE: Most abnormalities that are found on CT scan are not cancer, but they do lead to further testing, more radiation exposure, unnecessary anxiety for people worried about having cancer and even risky surgery. We are actually going to do some lung surgery on people just to prove that they don't have cancer.
KNOX: LeFevre says people who have an abnormal lung scan are going to have to be calm, patient and deliberate.
LEFEVRE: This is an anxiety that I have about lung cancer screening. If somebody hears they have a 5 percent chance that this is cancer, and then you say, well, let's wait three months and repeat your CAT scan, if the emotional response is no, let's do something now, then we're going to do a lot of harm in the process of doing a little good.
KNOX: A lot of patients will get unnecessary lung biopsies and even surgery. Dr. Kenneth Lin of Georgetown University thinks the task force is putting too much faith in lung screening.
DR. KENNETH LIN: They rank it with those tests that your doctor, if they're a good doctor, is supposed to bug you about to get done. And I don't feel that this test necessarily meets that criteria. I don't necessarily feel that patients should be pressured into getting this test done. But I think that's what the B recommendation signifies: it ought to be more or less routine.
KNOX: But Tom Murphy, a 61-year-old Maryland man, is convinced that annual screening prevented him from dying of lung cancer as his father did. Murphy, who smoked for three decades, started getting yearly lung scans in 2005 as part of a study. Five years later, a scan showed a spot on his right lung was growing.
TOM MURPHY: Oh, absolutely that scan saved my life. This thing started at five millimeters in January of 2010. And at the point they took it out, it was 1.2 centimeters, you know, nine months later. So I'm very grateful, and I believe to this day that it saved my life.
KNOX: But Murphy still has to get a lung scan every few months to see if something else is brewing. So he's not out of the woods.
MURPHY: I'd like to think that I am. But, you know, when I go down there, you know, they have this thing called scanxiety when you're a cancer patient. Before you - every scan, you go get, you get a little anxious or a lot anxious before your scan. I still get a little anxious before each scan.
KNOX: But in between scans, Tom Murphy relishes the times he can play with his new granddaughter. Richard Knox, NPR News.