This letter appeared on March 28, 2007 in the Wall Street Journal in reponse to Dr. Marc Siegel's March 15 editorial commentary "Stupid Cancer Statistics" (viewable with subscription):
Dr. Marc Siegel's op-ed calls for increased use of specialized ("spiral") CT scans to detect lung cancer early enough to intercept its deadly course. However, he is too quick to dismiss the crucially important ongoing scientific debate over whether such screening actually save lives over the long-term. Lung cancer is far and away the number one cancer killer in the U.S. and all countries where cigarette smoking is common. To detect cancers in a curable stage and help save 165,000 Americans from a cruel death each year would truly be miraculous. But rigorous studies have shown that detecting tiny nodules, even if cancerous, may not actually reduce mortality (cancer death). Dr. Siegel himself refers to the fact that merely demonstrating a longer survival time from diagnosis does not, necessarily, mean that lives will be saved five years hence -- rather it just extends the time measured between the (earlier) diagnosis and the same, fatal outcome.
Most importantly, he also neglects to take the downside risks of screening into account: false-positives are indeed common, and the diagnostic biopsies and needless major surgeries for benign or indolent nodules are not only costly but emotionally devastating and (in about one in twenty cases) result in severe or even fatal complications. Merely asserting that "my patients want to know if they have cancer" is not a valid way to deal with this frustrating puzzle. Siegel's use of one illustrative patient also flies in the face of evidence-based medicine: the plural of anecdote is not data. Large, randomized controlled trials are underway and need to be completed before we adopt potentially dangerous and costly screening programs that may do more harm than good.
Gilbert Ross, M.D.
Executive and Medical Director
American Council on Science and Health
New York
