Clinical trials might be considered rarified air, with all factors controlled for except for the one under investigation. At least that's the hope. Now, as Rick and I discuss on PodMed this week and published in JAMA Internal Medicine, when data from a single clinical trial is used as the basis to inform lung cancer screening, results from the real world, or at least the Veteran's Administration manifestation of it, aren't so stellar, and in fact, call into question whether such screening should be done at all.
Just over 2100 current or former heavy smokers who were part of the VA population underwent low dose CT for lung cancer screening, as recommended by the United States Preventive Services Task Force (USPSTF), at eight sites in the United States. Almost 60% of this group had lung nodules; of that number just over 56% required tracking. Only 1.5% had lung cancer. A variety of incidental findings were identified as might be expected, but in short, there was a huge burden of counseling, screening and follow up for a very modest identification of people whose lung cancer was still potentially curable. Does this mean that we should simply abandon the practice of screening? As Rick opines, what's really needed, and seems to be poised on the horizon, is an accurate, easy screening test with not much in the way of false positives or false negatives. Hopefully such a blood test will become practical in the very near future.
Other topics this week include two from JAMA Cardiology: Association of Transcatheter Aortic Valve Replacement With Quality of Life and Cardiac Sympathetic Activity in Electronic Cigarette Users, and in the Lancet: Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women. Until next week, y'all live well.