When the Average Applies to No One: Personalized Decision Making About Potential Benefits of Lung Cancer Screening
Authors: Peter B. Bach, Michael K. Gould
Journal: Annals of Internal Medicine (2012)

Ideas and Opinions16 October 2012When the Average Applies to No One: Personalized Decision Making About Potential Benefits of Lung Cancer ScreeningPeter B. Bach, MD, MAPP and Michael K. Gould, MD, MSPeter B. Bach, MD, MAPPFrom Memorial Sloan-Kettering Cancer Center, New York, New York, and Kaiser Permanente Southern California, Pasadena, California. and Michael K. Gould, MD, MSFrom Memorial Sloan-Kettering Cancer Center, New York, New York, and Kaiser Permanente Southern California, Pasadena, California.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-157-8-201210160-00524 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In 2011, four decades of studies of lung cancer screening came to fruition with the publication of the results of the National Lung Screening Trial (NLST). This trial found that for high-risk individuals, 3 rounds of annual screening with low-radiation-dose computed tomography (CT) reduced the relative risk for lung cancer death by 20% when compared with chest radiography screening (1). The medical community is poised to offer CT screening to patients at risk for lung cancer, and practice guidelines now recommend doing so in a manner that promotes informed patient choice (2, 3). Well-publicized potential harms of screening, such as ...References1. Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395-409. [PMID: 21714641] CrossrefMedlineGoogle Scholar2. Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, et al. Benefits and harms of CT screening for lung cancer: a systematic review benefits and harms of CT screening for lung cancer. JAMA. 2012;:1-12. [PMID: 22610500] MedlineGoogle Scholar3. American Lung Association. Providing Guidance on Lung Cancer Screening to Patients and Physicians. 23 April 2012. Accessed at www.lung.org/lung-disease/lung-cancer/lung-cancer-screening-guidelines/lung-cancer-screening.pdf on 25 May 2012. Google Scholar4. Elmore JG, Gigerenzer G. Benign breast disease—the risks of communicating risk [Editorial]. N Engl J Med. 2005;353:297-9. [PMID: 16034016] CrossrefMedlineGoogle Scholar5. Gigerenzer G. Making sense of health statistics [Editorial]. Bull World Health Organ. 2009;87:567. [PMID: 19704999] CrossrefMedlineGoogle Scholar6. Schwartz LM, Woloshin S, Welch HG. Risk communication in clinical practice: putting cancer in context. J Natl Cancer Inst Monogr. 1999;:124-33. [PMID: 10854468] CrossrefMedlineGoogle Scholar7. Bach PB, Kattan MW, Thornquist MD, Kris MG, Tate RC, Barnett MJ, et al. Variations in lung cancer risk among smokers. J Natl Cancer Inst. 2003;95:470-8. [PMID: 12644540] CrossrefMedlineGoogle Scholar8. Bach PB, Elkin EB, Pastorino U, Kattan MW, Mushlin AI, Begg CB, et al. Benchmarking lung cancer mortality rates in current and former smokers. Chest. 2004;126:1742-9. [PMID: 15596668] CrossrefMedlineGoogle Scholar9. Bach PB, Jett JR, Pastorino U, Tockman MS, Swensen SJ, Begg CB. Computed tomography screening and lung cancer outcomes. JAMA. 2007;297:953-61. [PMID: 17341709] CrossrefMedlineGoogle Scholar10. Cronin KA, Gail MH, Zou Z, Bach PB, Virtamo J, Albanes D. Validation of a model of lung cancer risk prediction among smokers. J Natl Cancer Inst. 2006;98:637-40. [PMID: 16670389] CrossrefMedlineGoogle Scholar11. Gohagan JK, Marcus PM, Fagerstrom RM, Pinsky PF, Kramer BS, Prorok PC, et al; Lung Screening Study Research Group. Final results of the Lung Screening Study, a randomized feasibility study of spiral CT versus chest x-ray screening for lung cancer. Lung Cancer. 2005;47:9-15. [PMID: 15603850] CrossrefMedlineGoogle Scholar12. Etzel CJ, Bach PB. Estimating individual risk for lung cancer. Semin Respir Crit Care Med. 2011;32:3-9. [PMID: 21500119] CrossrefMedlineGoogle Scholar13. Spitz MR, Hong WK, Amos CI, Wu X, Schabath MB, Dong Q, et al. A risk model for prediction of lung cancer. J Natl Cancer Inst. 2007;99:715-26. [PMID: 17470739] CrossrefMedlineGoogle Scholar14. Tammemagi CM, Pinsky PF, Caporaso NE, Kvale PA, Hocking WG, Church TR, et al. Lung cancer risk prediction: Prostate, Lung, Colorectal And Ovarian Cancer Screening Trial models and validation. J Natl Cancer Inst. 2011;103:1058-68. [PMID: 21606442] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Memorial Sloan-Kettering Cancer Center, New York, New York, and Kaiser Permanente Southern California, Pasadena, California.Acknowledgment: The authors thank Geoffrey Schnorr, BS (Memorial Sloan-Kettering Cancer Center), who provided administrative and editorial assistance.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0406.Corresponding Author: Peter B. Bach, MD, MAPP, 1275 York Avenue, New York, NY 10065.Current Author Addresses: Dr. Bach: Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.Dr. Gould: Kaiser Permanente Southern California, 100 South Los Robles Avenue, Pasadena, CA 91101.Author Contributions: Conception and design: P.B. Bach, M.K. Gould.Analysis and interpretation of the data: P.B. Bach, M.K. Gould.Drafting of the article: P.B. Bach.Critical revision of the article for important intellectual content: P.B. Bach, M.K. Gould.Final approval of the article: P.B. Bach, M.K. Gould.Statistical expertise: P.B. Bach.Administrative, technical, or logistic support: P.B. Bach.Collection and assembly of data: P.B. Bach.This article was published at www.annals.org on 14 August 2012. 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