X the X-ray for lung cancer detection

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Although the premise may seem logical screen people routinely for lung cancer in order to treat it early regular chest X-rays do not in any way reduce lung cancer mortality, a recent report in JAMA confirms.

In this large randomized prospective study conducted between 1993 and 2001, over 150,000 older Americans received either four annual chest X-rays or just regular care. The study found that those in the annual chest X-ray group were just as likely to die from lung cancer as those who received only usual care, even if they were current or former smokers. Each group of about 75,000 subjects had around 1,200 lung cancer deaths.

Even though the ineffectiveness of routine X-rays to reduce lung cancer deaths has long been known among the medical community, some doctors continue to recommend the exam. ACSH s Dr. Gilbert Ross hopes that this study will put a definitive end to this practice, not least because he sees it as a waste of time and money that does nothing to benefit patients, regardless of smoking status. In fact, he says, I thought this matter had been long-settled when I started practice in the 1970s.

The outcome of the chest X-ray research is consistent with a set of recent studies examining the risks and benefits of a variety of regular health screening procedures. Annual mammograms and PSA tests in particular have been under fire, as more studies identify the high risk of false-positive results and unnecessary procedures, compared to the low level of actual benefits.

As ACSH s Dr. Josh Bloom observes, It s both fascinating and disappointing that modern imaging technology can do only so much. When health care costs need to be cut, this is exactly the kind of information needed to make the best choices.

While routine chest X-rays may do nothing to improve lung cancer mortality rates, we reported earlier in the year on the beneficial effects of spiral CT scans for lung cancer screening. And, in fact, findings from a study sponsored by the National Cancer Institute last year showed that screening current and former smokers with spiral CT scans can reduce lung cancer deaths by 20 percent, compared to standard chest X-rays. Because lung cancer remains the biggest cancer killer in the United States diagnosed in 220,000 Americans a year and killing about 75 percent of this number advancements in earlier diagnosis and effective treatment will be especially important.

Smokers are at a hugely increased risk of developing lung cancer: Eighteen percent of smokers develop lung cancer by age 75, as opposed to only 1 percent of those people who have never smoked. Former smokers still remain at a higher risk of developing the disease, even after a decade of abstinence, although their risk is not as high as that of current smokers.