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Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

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Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#51

Post by 1e-9 »

robotrout wrote: post #26

Welch says, "but [can also] find cancers that were never going to matter." That's because some cancers grow slowly and never become dangerous, he says. This exact same phenomenon is already occurring with breast cancer. Everybody is a "breast cancer survivor" these days, because they keep finding these turtle tumors that were never going to be a problem. If you look at mortality rates between those who screen early a…

While it is true that there is plenty of uncertainty regarding the value of finding DCIS, it is well established that there is significant benefit to finding small invasive breast cancers such as invasive lobular carcinoma and invasive ductal carcinoma. The value is particularly significant if the lesions are found before exceeding 1 cm in size, which they often are nowadays. The paper sited refers to one study focused on DCIS and another Canadian study on breast cancer screening during the 1980's and 1990's before there were good mammography screening standards. The Canadian study essentially just showed that poor screening is of limited value.

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#52

Post by yalok »

elhudy wrote: post #35
linsomniac wrote: post #19

I've watched my family go through smoking, and cancer hasn't been the issue. I don't know how representative it is, but my experience definitely reflects the premise of this article: cancer testing could have caused way more harm than good. Both my mother and her father were still smoking frequently when they were on oxygen. In other words: When they should have known better. Her mother was looking really bad at 50 a…

This could be the most controversial thing comment I've posted on here, but...: Why are we even spending resources figuring out how to extend the lives of people who have smoked a pack a day, for 30 years, and are currently in old age? Even if we find cancer and save their lives now, will that prevent then from picking up smoking again? Will it prevent the heart disease they're going to encounter ten more years down…

Consider passive smokers - not guilty of anything, they just couldn’t avoid it. Like kids in the smoking families...

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#53

Post by DennisP »

nradov wrote: post #42
moftz wrote: post #36

Earlier quoted context omitted.

Those people (or their insurance) are willing to pay for treatment. If the market is there, why not fund some new research into treating lung cancer? Not every incidence of lung cancer is from smoking two packs a day, sometimes it just happens although its more rare. It's the idiots smoking two packs a day that are helping subsidize the research that can help save the person who just gets lung cancer randomly. I thin…

Unlike some other forms of cancer, random lung cancer is exceedingly rare. The vast majority of lung cancer patients were smokers. As a society we have limited resources for healthcare. So it's worth considering whether we might achieve better net results by shifting some resources from lung cancer treatment to smoking cessation programs.

I'm not sure what you mean by "exceedingly," but:

> Overall, 10 percent to 15 percent of lung cancers occur in non-smokers. (Another 50 percent occur in former smokers.)

> Two-thirds of the non-smokers who get lung cancer are women, and 20 percent of lung cancers in women occur in individuals who have never smoked. This percentage is significantly higher in Asian women.

https://www.verywellhealth.com/lung-cancer-in-non-smokers-22...

As for the smokers, they generally pay higher health insurance premiums so at least they're contributing their share of resources.

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#54

Post by EpicEng »

elhudy wrote: post #35
linsomniac wrote: post #19

I've watched my family go through smoking, and cancer hasn't been the issue. I don't know how representative it is, but my experience definitely reflects the premise of this article: cancer testing could have caused way more harm than good. Both my mother and her father were still smoking frequently when they were on oxygen. In other words: When they should have known better. Her mother was looking really bad at 50 a…

This could be the most controversial thing comment I've posted on here, but...: Why are we even spending resources figuring out how to extend the lives of people who have smoked a pack a day, for 30 years, and are currently in old age? Even if we find cancer and save their lives now, will that prevent then from picking up smoking again? Will it prevent the heart disease they're going to encounter ten more years down…

For the same reason we attempt to rehabilitate other types of drug addicts; they're still people with families and friends who want them alive for as long as possible. There are many societal constructs which are intended to help people who made poor choices.

I think it's a legitimate question though. I started smoking when I was 9, pack a day by 16.

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#55

Post by GalacticDomin8r »

nradov wrote: post #44
felipemnoa wrote: post #37

Earlier quoted context omitted.

>>Why are we even spending resources figuring out how to extend the lives of people who have smoked a pack a day, for 30 years, and are currently in old age? Slippery slope I guess (Plus it is immoral). Next somebody is gonna say why should certain kind of people get medical treatment instead of this other people who clearly deserve it more.

There's nothing inherently immoral about rationing healthcare. In fact healthcare is already rationed everywhere for most patients. In the US we mostly ration based on wealth, age, and employment status. But that doesn't necessarily mean other approaches are less moral.

> There's nothing inherently immoral about rationing healthcare.

That a subjective statement, it is only true for you and those who agree with you.

>In fact healthcare is already rationed everywhere for most patients.

That is not an argument for the morality of rationed healthcare.

We could make some sort of objective argument based upon ethics though. Suppose the smoker became addicted to cigarettes as a by-protect of being drafted into the military where he served in a distinguished role perhaps saving lives and protecting your freedom. Being a draftee and not particularly well educated, this persons means in retirement were quite limited, often depending on government assistance in various forms.

A different person was ensured to be wealthy by inheritance then draft dodging then engaging in tax evasion, illegal migrant labor, various kinds of fraud and strong arm tactics. Yet this person didn't smoke and is quite wealthy.

Should we invest in healthcare for tobacco users?

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#56

Post by babyslothzoo »

VOMIT, Victim Of Modern Imaging Technology, is a term among doctors for a reason.

Generally the more you know the better, but sometimes things can be stumbled upon that might otherwise be irrelevant yet the intervention can then introduce new risk or some other unique problem or undesired side effect. There aren't always easy answers.

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#57

Post by wswope »

dontreact wrote: post #27

False positives will be much more rare in practice with the new guidelines used (Lung RADS) which cut false positives by 50% or more while mostly preserving sensitivity. That doctor should really update his diagram to reflect the current standard of care for lung cancer screening. Using the false positive rate from the 2011 study is intellectually dishonest! In addition the amount of lung cancer deaths prevented was…

Honestly curious: are most radiologists actually following guidelines like Lung RADS in practice, especially just after publication? Is it part of any standardized CME?

It's my impression that there's often a big gap between ACR best practices and what's happening on the ground in most places, which was a key point the doctor in the article was making.

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#58

Post by NullPrefix »

pytyper2 wrote: post #40

I periodically smoke, yet I don't call myself a smoker. Yet when I buy insurance I buy the smokers plan, the idea being that if I do need to use the insurance I expect the Insurance company to use any information necessary to deny my claim. Should I be worried about this?

Have fun getting any physical activity injury claim denied. Smokers aren't expected to do sports.

/s

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#59

Post by skullborg »

lilbobbytables wrote: post #46
skullborg wrote: post #29

Earlier quoted context omitted.

Do share more stories on working on old trucks! I have a '99 Ford with a 7.3, and everyone's saying it's not worth fixing, but I just like keeping it on the road...

I thought the 7.3's were supposed to be super solid? How many miles does it have, what's wrong with it? My extremely limited knowledge of diesel engines is something like "they go a ton of miles, then need a major overhaul, then go a ton more miles". If you're at some kind of major overhaul milestone, then I could see the response you're getting. '99-ish Ford kicked off the Super Duty series, but it isn't sufficientl…

It's nearing 400k miles. It's had service - new turbo and engine control components, suspension and frontend, brakes, glow plugs, etc. Original everything else though, nothing fancy, just a work truck. But anything "newer", even 10 years old, is $25k minimum for any halfways decent duty truck.

Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)

#60

Post by skullborg »

WhompingWindows wrote: post #32
skullborg wrote: post #29

Earlier quoted context omitted.

Do share more stories on working on old trucks! I have a '99 Ford with a 7.3, and everyone's saying it's not worth fixing, but I just like keeping it on the road...

What kind of MPG does that get?

22-24 highway, 15 city. It has zero emissions equipment though, so I'm sure it's killing us all
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