Some also worry that medical professionals more interested in profits than evidence could frighten younger people or those who aren't heavy smokers into believing they should get a CT scan as well. Although most insurance programs and Medicare wouldn't cover an initial screening, once a scan finds something suspicious, insurance and Medicare will pay for further tests, biopsies and even surgery. Since a large percentage of scans will show something suspicious, hospitals or radiology centers stand to make money from the procedures.
"It's a gateway to having new patients," says Peter B. Bach, M.D., a lung specialist and epidemiologist at Memorial Sloan-Kettering Cancer Center in New York City, who warns of "the hucksterism that will surround" the findings. "The concern is that people will use this study and overblow the benefits, seriously soft-pedal the risk and start pushing this on people who are not at high risk," he says.
Sox says for all of these "false positives," there were relatively few biopsies and surgeries in the study, most likely because it was conducted with top doctors and technology at large medical centers.
But he adds that in order to duplicate the results of this study and reduce deaths from lung cancer in community practice, "you've got to have people who are really experienced, or else everybody has got to go to a big medical center where they do a lot of interpretation of these scans."
Some large medical systems are already poised to launch screening programs.
Based on the results of this trial, the University of Pittsburgh Medical Center, for example, will start advertising a new clinic offering lung cancer screening in the next few weeks aimed specifically at the group studied — those ages 55 to 74 who are smokers or have smoked within the past 15 years. For $200, people receive an hour of education about the scans and information about smoking cessation and a low-dose CT scan interpreted by a radiologist who will interpret the results and consult with a specialist.
"The results of this study are very important, suggesting that many Americans who smoke should not only quit smoking, but also undergo lung cancer screening with CT scans, both of which will reduce lung cancer mortality rates," says Mark Gladwin, M.D., chief of the division of pulmonary, allergy and critical care medicine at Pittsburgh. Other hospitals, medical centers and radiology clinics are sure to follow suit. Scans cost between $300 to $1,000, according to the National Cancer Institute, but costs can go much higher than that in some parts of the country.
Bach of Sloan-Kettering says it might be more worthwhile for the U.S. health care system to channel money into smoking cessation programs, which can prevent or reduce lung cancer risk, rather than funding the newest technology to find and remove the cancers after they've taken root.
Quitting smoking is a much more effective way to cut your risk of dying from lung cancer, he says. And, he adds, quitting smoking also reduces the risk of death from other "major killers" linked to smoking, including heart disease and other cancers.
Elizabeth Agnvall is a contributing editor of the Bulletin.