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)
#2> That's because some cancers grow slowly and never become dangerous...These false-positive tests led to more follow-up testing, including risky procedures like a biopsy, which inserts a needle into the lung.
> "Not surprisingly," Welch says, "sometimes that creates problems like causing someone's lung to collapse."
These outcomes should inform whether or not the biopsy needs to take place or whether they should instead follow up with further screens to monitor whether the cancer progresses. Of course, the major downside of my suggestion is that patients are extremely reluctant to hear "cancer" without a plan to rapidly classify it as malignant or benign.
Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)
#3> "but [can also] find cancers that were never going to matter."
I'm not sure, but isn't better to know that you have it and then investigate further, do more tests, perhaps do some period follow-up with a shorter interval?
Otherwise it's just betting: I bet that I don't have a lung cancer that will be agressive....
Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)
#4Anecdotally, as an ex-smoker who quit after my mother died from lung cancer, I spoke to my doctor about screening. He did a lot of dismissing and hand waving about it. It upset me greatly at the time. This article explains it all well enough. Doctor/patient communication is very important.
Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)
#5Anecdotally, as an ex-smoker who quit after my mother died from lung cancer, I spoke to my doctor about screening. He did a lot of dismissing and hand waving about it. It upset me greatly at the time. This article explains it all well enough. Doctor/patient communication is very important.
If you don't feel like you doctor is addressing your concerns, seek a second opinion. You are your own best patient advocate.
Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)
#6> "but [can also] find cancers that were never going to matter." I'm not sure, but isn't better to know that you have it and then investigate further, do more tests, perhaps do some period follow-up with a shorter interval? Otherwise it's just betting: I bet that I don't have a lung cancer that will be agressive....
"investigate further" is the sticking point.
You're swimming in the ocean and notice something beneath you. Is it a friendly dolphin or a dangerous shark? Do you hold your breath and do a deep dive to figure out which it is? Keep in mind the deeper you go the greater the chance that you'll drown.
It's a strained analogy but I think it gets at the problem. What if you dive a little bit deep - some minor test - and still aren't sure? Go deeper - a more invasive dangerous test - or go back to the surface?
And what if you dive and are pretty sure it's a shark? Swimming all the way to shore (i.e. cancer treatment) is very risky but the shark will almost certainly kill you. How sure are you, really?
Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)
#7This sounds familiar. I have watched now quite a few people go through serious diseases. One pattern I saw was tests, tests and more tests. A lot of them very expensive, time consuming and painful. But when you ask what they will do with the test results there often is silence. To me it looks like they are doing something because “we need to do something”.
Reminds me a little of data collection practices at companies. Sucking up more data feels like you are doing something. But using the data is much more difficult and often doesn’t happen.
Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)
#8> "but [can also] find cancers that were never going to matter." I'm not sure, but isn't better to know that you have it and then investigate further, do more tests, perhaps do some period follow-up with a shorter interval? Otherwise it's just betting: I bet that I don't have a lung cancer that will be agressive....
* Choice A: X% chance of aggressive cancer, which worsens as it is left untreated.
* Choice B: X% chance of finding and treating aggressive cancer. Y% chance of false positive leading to significant side effects.
If Y is zero, then the choice to do further testing is obvious. If Y is large, then it depends on how large the side effects are, and what the chance of running into them is. You have risk in either case, and you will never reduce risk to zero. The question is how much risk you have, and what cost there is to mitigate that risk.
Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)
#9tl; dr: the false positive rate is too high.
Re: Why Some Doctors Hesitate to Screen Smokers for Lung Cancer (2015)
#10> "but [can also] find cancers that were never going to matter." I'm not sure, but isn't better to know that you have it and then investigate further, do more tests, perhaps do some period follow-up with a shorter interval? Otherwise it's just betting: I bet that I don't have a lung cancer that will be agressive....
"investigate further" is the sticking point. You're swimming in the ocean and notice something beneath you. Is it a friendly dolphin or a dangerous shark? Do you hold your breath and do a deep dive to figure out which it is? Keep in mind the deeper you go the greater the chance that you'll drown. It's a strained analogy but I think it gets at the problem. What if you dive a little bit deep - some minor test - and sti…
“You're swimming in the ocean and notice something beneath you. Is it a friendly dolphin or a dangerous shark? Do you hold your breath and do a deep dive to figure out which it is? Keep in mind the deeper you go the greater the chance that you'll drown.”
Does it really make a difference what it is? Will you do anything differently?