Seminars in ultrasound, CT, and MR
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Semin. Ultrasound CT MR · Feb 2003
Randomized Controlled Trial Multicenter Study Clinical TrialCT screening for lung cancer.
The Early Lung Cancer Action Project (ELCAP) recently demonstrated that earlier diagnosis of lung cancer can be achieved with CT, and these results have led to considerable demand for CT screening. The advisability of screening seems obvious, as screening has been shown to provide for lung cancer treatment at a relatively early stage, leading to a better chance to avert death from lung cancer than when treatment is prompted by symptoms and/or signs. There are, however, countervailing ideas that CT lung cancer screening has not yet been demonstrated to 'save lives.' Further, it has been stated that CT screening has a notable problem of "overdiagnosis," meaning that screening finds lesions that are not life threatening, leading to unnecessary surgery. ⋯ We feel that randomization is not necessary for evaluating a diagnostic test and may generate misleading results. Rather, we feel that the desired information is how often and how early is the disease diagnosed using that test. The purpose of this article is to raise the general level of concern about the underpinnings of such randomized 'screening' trials, and to convey some of the evidence that led to our pessimism about the NLST.