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ABC lung-cancer report lacked balance and nuance, says media expert Schwitzer

On Thursday morning, Gary Schwitzer, publisher of the Minnesota-based HealthNewsReview blog, posted a piece on an “amazingly unbalanced report” by ABC News on the latest data analysis from the National Lung Screening Trial (NLST), which was released earlier this week.

Dr. Gary Schwitzer
Courtesy of HNR
Dr. Gary Schwitzer

The ABC News broadcast reported only one side of the NLST findings — that more aggressive lung-cancer screening was associated with a reduced risk of lung-cancer deaths — while ignoring the risks associated with that screening, writes Schwitzer. The broadcast “offered no discussion of false positives, no discussion of cost, but used hyperbolic, promotional language,” he notes. ABC even offered to help viewers find hospitals who would scan them.

“Journalism? Or advertising?” asks Schwitzer.

By Thursday night, ABC had removed the video of the broadcast from its website. But not, unfortunately, before presumably millions of people had seen it.

This is not the first time (nor presumably the last), Schwitzer notes, when the media has taken a screening study and focused on the possible benefits of a procedure while ignoring its risks.

Who can forget the very nasty debate over the often-misreported U.S. Preventive Services Task Force’s 2009 recommendations regarding breast-cancer screening?

Benefits — but with a cost
The NLST study compared two different lung-cancer screening methods — chest X-rays and low-dose CT scans — on a group of people at high risk for developing lung cancer: smokers and former smokers ages 55 to 74. The study found 20 percent fewer lung-cancer deaths among those screened with CT scans than among those who received the chest X-rays.

Those are impressive and encouraging findings. But, as Dr. Harold Demonaco, director of the Innovation Support Center at the Massachusetts General Hospital and one of Schwitzer’s medical reviewers, points out, the study also found that lung-cancer screening of large populations comes with some very real health risks:

There was a cost to those lies saved. 26,722 people were screened with CT scans and 6,413 had a suspicious lesion that required follow up. Of those, 6,182 were found to be false positives. This compared to 1,844 positive findings with X-ray and 1,743 false positives. More suspicious lesions found is a good thing but not without cost. 75 of the folks who had a false positive finding on CT had a major complication associated with the follow up studies and compared to 24 in the chest X-ray group.

Schwitzer also highlights the cautious comments of Dr. Otis Brawley, chief medical officer of the American Cancer Study, who points out the “very sobering observation in this report that there were 26 deaths associated with invasive diagnostic procedures.”

Dr. Otis Brawley
Courtesy of ACS
Dr. Otis Brawley
Guidelines groups have yet to carefully evaluate these and other data to determine who should and should not consider undergoing screening for early lung cancer detection and how often. Best practices have yet to be defined and in place in all clinical settings that will offer screening and diagnostic procedures, nor are we prepared to articulate the details that high risk individuals should hear before making a decision to undergo screening. …
[I]f and when major groups do make a recommendation for screening it will be important that those considering screening be made aware of the significant number of false positives findings and potential other harms associated with downstream testing that can occur with spiral CT scanning.”

That side of the story was missing from ABC’s report on the NLST study, says Schwitzer. “We know that journalists struggle with screening stories. A simple reminder may help them do a better job: All screening tests do harm; some may also do good. If you don’t reflect that in your story, you’re probably doing harm as well.”

That reminder should help consumers, too, as they read and watch media reports on preventive-screening studies.

NOTE: You can still view the ABC segment on the NLST study at about 4:25 at this link.

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