You can pay me now…

Tuesday, November 9, 2010

“CT scans of smokers cut lung cancer deaths.” The Washington Post
“CT screening cuts lung cancer death better than X-ray: study.” Yahoo news
“CT Screening for Lung Cancer among Heavy Smokers Saves Lives” Science Café. University of California, San Francisco

Headlines deceive and should remind us that and ounce of prevention is worth a pound of cure. When it comes to smoking and cancer, the CT’s pound of cure may cost more than it’s worth. Unfortunately, the high tech CT scan with its glitz will probably win out over common sense and frugality.

The National Cancer Institute stopped the National Lung Screening trial early because it found that smokers who were screened with CT scans for lung cancer had 20% fewer lung cancer deaths than those who had a plain chest x-ray. 20% is an impressive number but in reality it translated to 86 extra deaths. Compare that number to the 157,000 people who will die from lung cancer in the United States this year, next year and every year to come. And that death number increases to 443,000 every year for all preventable smoking related deaths including heart disease, lung disease and stroke.

Prevention is less exciting and the poor stepchild of the public health budget. Just like the deficit will be left to burden future generations, the lack of funding for smoking prevention and stop smoking education will cause millions to die twenty and thirty years from now. Government agencies charged with educating the public about the dangers of tobacco have failed to fund those programs, using money that had been paid by tobacco companies specifically for that purpose to be spent elsewhere.

When governments were flush with money, quit smoking hotlines and smoking prevention programs flourished and millions fewer Americans have started or continue to smoke. Now with increased pressure to cut budget deficits, smoking education money has gone away and the number of smokers may increase. 46,000,000 people smoke in the United States, more than 20% of the population.

The cancer CT screening for lung cancer studied smokers who had indulged for at least 30 years. Though the researchers made no recommendations about when and how often a screening CT should be done, it might be reasonable to presume that more than 40 million scans might be done thirty years from now. At $300 or more per scan, we’re leaving a yearly legacy of more than $12 billion to screen for just one of the preventable diseases caused by tobacco. Alternatively, we might encourage our government officials to work harder at putting tobacco companies out of business by making the demand for their product disappear.

CT scans don’t cure cancer or prevent death. A positive test that might identify a cancer can lead to care provided by surgeons, lung and cancer specialists. Surgery, chemotherapy and radiation therapy may be required. And not all positive tests are cancer. There was a 25% false positive rate meaning that the CT images looked like cancer, but no cancer was there. It seems that investing the money up front in might prevent the time, expense and anguish of trying to combat a deadly disease.

Perhaps the while situation can be best summarized by a Fram oil filter commercial:
“You can pay me now, or you can pay me later”

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