Annual Cancer Scans (for Smokers)

New recommendation for doctors could mean cultural change.
House Speaker Henry T. Rainey of Illinois poses for Helen Coolidge, daughter of Sen. Marcus Coolidge, in April of 1933. (AP)

Soon 10 million American tobacco smokers could be getting annual CT scans to look for lung cancer. That's if we go the way of a just-released draft of a recommendation from the U.S. Preventive Services Task Force, which portends potential for tens of thousands of cancer deaths averted.

Lung cancer is the leading cause of cancer death in the United States, and most people diagnosed with smoking-related lung cancer die from it. Still 37 percent of U.S. adults are current or former smokers. This new recommendation would apply to people between 55 and 80 years old who smoked (at least a pack a day) for 30 cumulative years, even if they quit smoking long ago.

Here's the risk/benefit breakdown they cite, which you can click through to enlarge. And here's an online module from Memorial Sloan-Kettering made to tell if you might be a candidate for screening.

So, why is this even a question? Why don't we just screen everyone for lung cancer? Why don't we screen everyone with full-body CT scans every year? Every month? Week, day?

1. CT scans involve ionizing radiation, which itself causes cancer. Roughly one in 10,000 screening CTs will actually cause a cancer that eventually kills the person. They're invaluable diagnostic tools, but not worth doing on a whim.

2. CT scans cost a lot of money. Under the new health care law, these scans wouldn't involve a co-pay for the patient. The cost is shared by everyone. (But the even-more-costly treatment of long undetected advanced-stage lung cancer would be, too, so.)

3. CT scans find problems that we didn't need to find but are obligated to further evaluate (more scans, biopsies, follow-up appointments), which costs more money and time and anxiety over things that turn out to be nothing.

4. Most interesting to me is the idea that more CT screening could enforce a false sense of security for smokers. More people might start/continue smoking. (It's fine, I'll just get cancer-screened.) But they're still at higher risk of many other cancers, and treatment of lung cancer still wouldn't be pleasant or without risks.

As the promisingly-heated discussion around this recommendation plays out, the bottom line remains that there are safer ways to get chemicals into our bodies than burning things and inhaling the smoke.

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James Hamblin, MD, is a senior editor at The AtlanticHe is the host of If Our Bodies Could Talk.


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