Thursday, November 4, 2010

CAT Scans, Lung Cancer, Heavy Smokers and Who Pays?

The NCI issued a report on a trial it performed regarding the use of period CAT scans on heavy smokers. They report:

"... researchers found 20 percent fewer lung cancer deaths among trial participants screened with low-dose helical CT relative to chest X-ray. This finding was highly significant from a statistical viewpoint."

On the down side the report states:

Are there radiation exposure risks associated with repeat CT scans? The radiation exposures from the screening done in the NLST will be modeled to see how exposure to three low-dose CT scans changed a person’s risk for cancer over the remainder of his or her life, but that analysis will take a while to conduct. Previous studies show that there can be an increased lifetime risk of cancer due to ionizing radiation exposure. It is important to recognize that the low-dose CT used for screening in the NLST delivers a much lower dose of radiation than a regular diagnostic CT. Additionally, the benefit of potentially finding a treatable cancer in current or former heavy smokers, ages 55 to 74, using helical CT appear to outweigh the risk from receiving a low dose of radiation.

Yes indeed there are risks. Thyroid, melanoma, breast, ocular, and other tumors are possible.

They then stated how this was paid for. Namely:

  • People participating in the trial were screened free of charge with either low-dose helical CT or chest X-ray.
  • Costs for any diagnostic evaluation or treatment for lung cancer or other medical conditions were charged to the participants in the same way as if they were not part of the trial. A participant’s medical insurance plan paid for diagnosis and treatment according to the plan’s policies. Participants who had no insurance were referred to local community resources to receive needed evaluations.
  • In addition to the low-dose helical CT scans and chest X-rays that all of the centers performed, some NLST centers also collected samples of blood, urine, or sputum for future lung cancer studies. These procedures were performed without charge.
Now the key question going forward is: given that we now have a CER study showing efficacy of a testing procedure, yet the whole reason for the test is a personal life style choice, should this procedure be paid for by the Government. Better yet, since I have never smoked cigarettes in my life, why should I be taxed to pay for the heavy smoker who deliberately places his life at risk?

What about the surgery necessary for a tight rope walker, they have taken on the risk and they should personally take on the costs.

I believe that this is a clear example of CER which can go wild. The usefulness of the procedure is most likely high but the procedure is necessary only because of a personal choice.