Overstating the evidence for lung cancer screening: The International Early Lung Cancer Action Program (I-ELCAP) study

H. Gilbert Welch, Steven Woloshin, Lisa M. Schwartz, Leon Gordis, Peter C. Gøtzsche, Russell Harris, Barnett S. Kramer, David F. Ransohoff

Research output: Contribution to journalArticle

Abstract

Last year, the New England Journal of Medicine ran a lead article reporting that patients with lung cancer had a 10-year survival approaching 90% if detected by screening spiral computed tomography. The publication garnered considerable media attention, and some 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 unbiased 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 prolonged by early detection, even when deaths are not delayed nor any lives saved, and (2) randomized trials are the only way to reliably determine whether screening does more good than harm.

Original languageEnglish (US)
Pages (from-to)2289-2295
Number of pages7
JournalArchives of Internal Medicine
Volume167
Issue number21
DOIs
StatePublished - Nov 26 2007

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Early Detection of Cancer
Publications
Lung Neoplasms
New England
Survival
Spiral Computed Tomography
Medicine
Outcome Assessment (Health Care)
Physicians
Control Groups
Lead

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Welch, H. G., Woloshin, S., Schwartz, L. M., Gordis, L., Gøtzsche, P. C., Harris, R., ... Ransohoff, D. F. (2007). Overstating the evidence for lung cancer screening: The International Early Lung Cancer Action Program (I-ELCAP) study. Archives of Internal Medicine, 167(21), 2289-2295. https://doi.org/10.1001/archinte.167.21.2289

Overstating the evidence for lung cancer screening : The International Early Lung Cancer Action Program (I-ELCAP) study. / Welch, H. Gilbert; Woloshin, Steven; Schwartz, Lisa M.; Gordis, Leon; Gøtzsche, Peter C.; Harris, Russell; Kramer, Barnett S.; Ransohoff, David F.

In: Archives of Internal Medicine, Vol. 167, No. 21, 26.11.2007, p. 2289-2295.

Research output: Contribution to journalArticle

Welch, HG, Woloshin, S, Schwartz, LM, Gordis, L, Gøtzsche, PC, Harris, R, Kramer, BS & Ransohoff, DF 2007, 'Overstating the evidence for lung cancer screening: The International Early Lung Cancer Action Program (I-ELCAP) study', Archives of Internal Medicine, vol. 167, no. 21, pp. 2289-2295. https://doi.org/10.1001/archinte.167.21.2289
Welch, H. Gilbert ; Woloshin, Steven ; Schwartz, Lisa M. ; Gordis, Leon ; Gøtzsche, Peter C. ; Harris, Russell ; Kramer, Barnett S. ; Ransohoff, David F. / Overstating the evidence for lung cancer screening : The International Early Lung Cancer Action Program (I-ELCAP) study. In: Archives of Internal Medicine. 2007 ; Vol. 167, No. 21. pp. 2289-2295.
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