Validation for smokers' CT scans but at what cost?

You find that a very expensive test delivers a good result. Who gets it? Who doesn't?

It is billed as great news for smokers and ex-smokers.

A report in Radiology, covering the National Cancer Institute's National Lung Cancer Screening Trial, shows death from lung cancer can be cut 20% if heavy smokers, and ex-smokers, get an annual helical CT scan instead of just a chest x-ray.

In a helical scan, which is currently used most often for bones, the x-ray tube spins so that many images are taken from different angles. In some models the table also rotates.

This is expensive stuff. A used unit can cost $300,000. (This one I found on eBay.) A single scan can cost $400.

The cost has made the test controversial.

A study published in 2005 was inconclusive. A Mayo Clinic study of the technique was critiqued as showing little difference in mortality. This was a more solid result, with more participants, done over time.

But while Health Jackal calls the result dramatic and notes the test was stopped early to report the result, an AP writer called the difference modest and a Philadelphia headline writer used the word "slightly."

Why? Cost.

Figure 20% of adults smoke. There are 91.5 million current or former smokers in the U.S. Lung cancer is diagnosed 196,000 times a year in this country, and 159,000 die from it each year, one third of all cancer deaths. The five-year survival rate is 15%.

This test cuts mortality risk 20%, because it finds tumors before they show up on a regular x-ray. It's the first good news in years.

But how much smoking is "heavy," for how long. At what point does the benefit of an annual test of this type exceed the risk from radiation -- CT scanners use x-rays, too. Even if money grows on trees there are a limited number of machines. Priorities have to be set.

But this is the elephant in the room with all studies of this type. You find that a very expensive test delivers a good result. Who gets it? Who doesn't?

The Centers for Medicare and Medicaid Services are going to come under serious pressure to cover annual spiral CT scans for ex-smokers. What should its priority be? What should insurers do?

The question has been called. What say you?

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