The New York Times Contradicts itself on Cancer Screening

At times, it feels like the New York Times understands the pitfalls and limitations of cancer screening. There are false scares, yes, but more problematic is not every “cancer” (cells that invade the basement membrane) needs to be treated. Not all “cancer” will kill you. At times, they seem to get this.

At times, they seem to understand the perils of overdiagnosis.

Then it is surprising to read a very uncritical article about CT screening for lung cancer. The title tells us the scan saved his life! The conclusion has already been reached, dear reader. Nothing to see here. Lives saved. Why aren’t you already in the scanner?

But what precisely happened? A 69 year old former smoker underwent CT screening for lung cancer in 2021. It found a stage 1 cancer, leading to surgery….

A stage 1 cancer, and, then a lot of scans, and another stage 1 cancer. And now he is on a TKI? for 3 years?

Only osimertinib and alectinib are approved in stage Ib, and osi only has data for 3cm + tumors and alec only 4cm and larger. And even here the data is dubious. The gains in the trials are from the higher stages.

Given how frequent the surveillance scans were, I highly doubt the patient has a tumor so large. This case— light on detail— really smells like inappropriate adjuvant therapy. I would love the reporters to have asked questions as to whether this treatment— which has side effects is appropriate. How large is his tumor? What study justfies adjuvant therapy? What has he been told the benefit is?

But the bigger question:

Does finding two stage 1 lung cancers mean his life was saved? It is completely unknown. What would the natural history of these tumors be otherwise? We don’t know. What is known for sure is that the patient has had 2 surgeries (minimun) and is on a cancer pill for 3 years.

What do we know about lung cancer screening?

We know there is no all cause mortality benefit. Here is NLST

And here is Nelson— the two trials mentioned in the NYtimes article.

Yet, this is not mentioned in the article. If you don’t increase overall survival in a randomized study, how can you say lives are saved?

Finally, I have no issue with the NYTimes running an essay arguing that many doctors believe CT screening for lung cancer saves lives, and we ought to expand those efforts, if the essay also acknowledged: however there is disagreement. The key randomized trials don’t show all cause mortality benefits. Some experts questioned whether a stage 1 patient should be on a TKI for 3 years— as the toxicity may outweigh the benefit. Moreover, those randomized trials did a bad job of post-protocol care for the control arm.

Instead, journalism is uncritical, and woefully inadequate for the public. If you want a different perspective, read only of my most popular articles from Sensible Medicine

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