CT Scans for Lung Cancer: Whose Interest?

Lung Cancer, No Worries?

The New York Times reported today that a study promoting CT scans for early lung cancer detection published in the New England Journal of Medicine was supported in part by a cigarette company. Funds for the research came from the Foundation for Lung Cancer: Early Detection, Prevention & Treatment, a group funded by $3.6 million dollars from the Vector Group, the parent company of the Liggett Group.

The New England Journal of Medicine published the study by Dr. Henschke et al, "Survival of Patients with Stage I Lung Cancer Detected on CT Screening The International Early Lung Cancer Action Program Investigators" in 2006. The authors concluded that "annual spiral CT screening can detect lung cancer that is curable", which was optimistic on two fronts. 1) The idea that lung cancer is detectable would be well received by doctors and patients because lung cancer is not usually detected in time for successful treatment. 2) If lung cancer were treatable, that is if Stage I cancers were "curable", as the authors concluded, this was very positive news considering that the mortality rate for all lung cancer is high. Both of these ideas could quell fears of some concerned smokers and health workers. More and more, cancer is considered a chronic disease not necessarily a fatal one, but lung cancer is still one of the deadliest.

The study results, if repeatable, could potentially change (some people's) perceptions about the dangers of smoking, and the paper got a lot of attention. The study authors compared CT scans to mammography scans and concluded that you could prevent 80% of deaths from lung cancers in at risk populations. If the results were that significant, if CT scans helped treat cancer, and if policy followed from the authors' conclusions, one might see an increase in the number of routine CT scans performed in the US.

Not. But What About a CT Scans?

As with most science everyone wants to see more studies done, especially since eyes are on Cornell-Weill study's methodology and conclusions. The idea to test greater numbers of people from risky populations also has also interests doctors and public health practitioners. But doctors have also expressed concern that if its recommendations were enacted patients could risk overdiagnosis since the testing produces false positives and there are concerns about exposing populations to CT radiation. To this end the NIH is funding the a $200 million dollar National Lung Screening Trial which tracks 50,000 smokers using CT scans through the agency's National Cancer Institute, .

But that study has also been dogged by some concerns. The Wall Street Journal wrote an article last October suggesting that two of the researchers in the multicenter study also had conflicts of interest for work they had done for tobacco companies testifying about the safety of CT scans. The Lung Cancer Alliance wrote letters to the NIH calling their attention to possible bias. The Lung Cancer Alliance is supported by donations and grants including $100,000 from General Electric, the company that makes CT scanners.

Two researchers, Dr. Denise Aberle of UCLA and Dr. William Black of Dartmouth, each testified on behalf of tobacco companies in state lawsuits. The defendants in the cases wanted the tobacco companies to pay for CT diagnostic screens. Aberle earned $30,750 from American Tobacco by testifying against the state of Louisiana, saying that CT scans were "reckless or irresponsible to promote". Black reportedly earned $700 from Phillip Morris for testimony for that company against the state of New York. He said CT screening "may do more harm than good."

The NIH asks that researchers involved with government studies report conflicts of interest to the institutions that employ them. Most of those institutions, as Acronym Required has discussed before, refuse to impose restrictions on research funding sources, and in fact aren't eager to divulge their policies on controversial funding from industries like tobacco. CT scanning is a powerful tool, but the most appropriate use for lung cancer detection is still under study. With the forthcoming NIH study results due next year, the investigation of these important research questions is clouded by contentions of conflict of interest on both sides.

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