Wednesday, October 17, 2018

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On the NELSON trial

I remember that in med school years ago, we were taught that there were no data to support screening for lung cancer. Screening involves detecting the early stages of disease among individuals who do not yet manifest it completely in order to reduce deaths from such disease. Studies have proven effectiveness of mammograms for breast cancer and Pap smears for cervical cancer, but, until recently, no screening procedure was recommended for lung cancer, which remains one of the hardest cancers to treat, given its aggressiveness.

The NELSON trial, published in the New England Journal of Medicine in 2011, determined if performing low dose CT scan compared to chest X-rays, actually reduced mortality among men and women at high risk for the development of lung cancer—i.e., at least 30-pack year smokers. It looked into 53,454 persons for many years and looked into the rates of development of lung cancer among these people.

The study highlights the following results:

There were 247 deaths from lung cancer per 100,000 person-years in the low-dose CT group and 309 deaths per 100,000 person-years in the radiography group, representing a relative reduction in mortality from lung cancer with low-dose CT screening of 20.0% (95% CI, 6.8 to 26.7; P=0.004).

That's 20% reduction in deaths—a clinically and statistically significant result.

In an ideal world, we'd request low dose CT scans in these subsets of patients, but in a country where much of health care is shouldered by patients, this may not be done at all, given the cost (at least Php 5000.00). Many questions arise from this trial: how often do we do CT scans? Do we get the same benefit if we screen non-smokers? We expect the answers to these in the coming years.

The best way to decrease lung cancer deaths is, of course, smoking cessation. If you haven't stopped smoking, please do so now—a friendly and urgent reminder.

2 comments:

  1. Yes, please stop smoking!! Someone in our apartment complex goes out to smoke at 2-3am and their smoke drifts in to our window, sometimes waking me up with the stink.

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    Replies
    1. Hay. Smokers know they need to stop smoking, but it is an addiction and will need a lot more willpower and even medication to overcome. As a Christian, I believe it may also need a change of heart.

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