SPECIAL ARTICLE Overstating the Evidence for Lung Cancer Screening

L ast year, the New England Journal of Medicine ran a lead article reporting that patientswith lung cancer had a 10-year survival approaching 90 % if detected by screening spi-ral computed tomography. The publication garnered considerable media attention, andsome felt that its findings provided a persuasive case for the immediate initiation of lung cancer screening. We strongly disagree. In this article, we highlight 4 reasons why the publication does not make a persuasive case for screening: the study had no control group, it lacked an unbi-ased outcome measure, it did not consider what is already known about this topic from previous studies, and it did not address the harms of screening. We conclude with 2 fundamental principles that physicians should remember when thinking about screening: (1) survival is always pro-longed by early detection, even when deaths are not delayed nor any lives saved, and (2) random-ized trials are the only way to reliably determine whether screening does more good than harm. Arch Intern Med. 2007;167(21):2289-2295 There is no cancer for which screening ought to bemore seriously considered than lung cancer. Each year, 160 000 Ameri-cans die from the disease—a number that surpasses that of the next 4 most deadly solid tumors combined (colon, breast