As with any new diagnostic test that is expensive, many medical policy skeptics decry the use of diagnostic imaging based on ever-increasing health care costs. The Newsday article says that some medical policy experts have questioned the cost of cancer screenings of all kinds, citing false positives. I have written extensively on this topic before, and whenever medical policy experts get involved, you must always ask what their hidden agenda is. Typically it involves trying to reduce healthcare costs associated with diagnostic tests and treatments. Many of the so-called “policy experts” believe diagnostic tests and treatments are “unnecessary.”
The next time somebody tells you that you may have the early stages of a fatal disease, ask them what they would do if there was a test available that would detect this at an early-stage. Ask them whether they are willing to forgo early diagnosis and treatment of lung cancer in order to save an insurance company from paying $500-$1000 for diagnostic test. According to this government study, a CT scan is effective in diagnosing early lung cancers.
Dr. Harry Raftopoulos, a medical oncologist at North Shore-LIJ's Monti Cancer Center was quoted as saying there are no screening standards currently. The only ones in use are the ones created for this project to determine which patients would be right for this study. Interestingly, he asked a pressing question: "What are doctors supposed to do when they diagnose an abnormal finding? He said there may also be a risk of exposing patients to unnecessary biopsies as a result of abnormal findings. However, both experts noted above predicted that their hospitals would eventually develop CT screening criteria that would allow patients to undergo this lung cancer screening test.
The article also quoted Dr. Jeff Schneider, director of lung cancer program at Winthrop University Medical Center saying that this study is groundbreaking. Hopefully, with early detection, patients can receive early diagnosis and treatment, which is exactly the goal for both doctor and patient.
The key word in this report is "routine." This is actually a very good study. There's a big difference in value between a "routine" colonoscopy, pap test, mammogram and flu shot than there is for a "routine" chest CT. If we ALL got "routine" CT scans, a LOT of non-disease requiring further workup would be done, including repeat CT scans and biopsies. Example: my wife did some work with a radiologist who was a proponent of "routine" whole body CT scans. Because he offered to do one on her for free, she did. (I should mention that he had just installed the scanner in his own office.) A small spot showed up. Three more scans and two years later, nothing changed. It's merely a common valley fever nodule from living in Arizona for 20 years. The doctor for whom she was doing the consulting with the radiologist (long story) decided 6 years ago not to include "routine" CT scans in the company's executive physical program. Now, if you have a history of lung cancer, are a smoker, have a chronic cough, or worked in a mine or asbestos factory, getting a CT scan of the chest is NOT routine. Notice the difference.
by Chuck Pilcher MD FACEP November 17, 2010 at 01:19 AM
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