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Journal of Clinical Oncology, Vol 23, No 10 (April 1), 2005: pp. 2439-2440 © 2005 American Society of Clinical Oncology. DOI: 10.1200/JCO.2005.05.151
Overestimation of Lung Cancer Mortality in a Computed Tomography–Screened PopulationDepartment of General and Oncologic Surgery, City of Hope National Medical Center, Duarte, CA To the Editor: In their article in the June 1, 2004 issue of the Journal of Clinical Oncology, Patz et al1 claim that they "made every effort to construct a conservative model that should, if anything, underestimate the true mortality" in predicting lung cancer population mortality in a computed tomography (CT) -screened population. I believe that this statement is inaccurate. Dr Patz estimates the 5-year survival (and conversely, mortality) of various stages of lung cancer, based on information from symptom-detected lung cancers. A more accurate estimate of lung cancer survival is to be found in a recent publication by the same author (Patz et al)2 showing 5-year survival at approximately 85% in a large series of patients with stage IA non–small-cell lung cancer. When only this one survival figure is substituted for the 61% survival number used by Patz et al in their predictive model, a very different result is calculated, as listed in Tables 1 and 2.
When compared with the control group from the Mayo Lung Project study, the population mortality estimates (2.72 and 2.33) strongly suggest that computerized tomographic screening will lower non–small-lung cancer population mortality as well as improve survival in screen-detected cancers. If Duke University Medical Center survival data for stages IB through IV were incorporated into the model, the difference would favor screening even more strikingly. Readers of this Journal should be cognizant of one additional fact about lung cancer screening. The tobacco industry has a vital stake in convincing the public and the courts that lung cancer screening is ineffective, and perhaps dangerous. If lung cancer screening is considered to be effective, then the tobacco industry is at considerable risk of being forced to pay billions of dollars for "medical monitoring" CT scans in class action lawsuits brought forward by consumers of tobacco-industry products who are at high risk for death from lung cancer. In fact, two such lawsuits have already concluded, in the states of West Virginia and Louisiana. Multiple articles written by Dr Patz and his colleague Dr Philip Goodman of Duke University (Durham, NC) were prominently cited in these trials and helped convince the juries in each case to rule in favor of the tobacco industry, and against the use of lung cancer screening in smokers and ex-smokers in those states. Goodman, who coauthored six previous articles with Dr Patz,2-7 was an expert witness for the tobacco industry in the West Virginia case, arguing against lung cancer screening. He testified that he was paid between $80,000 and $100,000 by the tobacco industry (unpublished jury trial transcript, tobacco litigation case No. 00-C-6000, Wheeling, WV, trial beginning October 25, 2001).8 Dr Patz has stated that he has no potential conflicts of interest with respect to the tobacco industry, but documents available at the University of San Francisco Library of Tobacco Industry Documents (San Francisco, CA) show that Patz applied for research funding from the notorious Council for Tobacco Research in May 1994. He did not receive funding (EF Patz Jr, MD, unpublished data, July 28, 1994. Available at the Legacy Tobacco Documents Library, http://legacy.library.ucsf.edu/tid/azq16d00). Tobacco industry documents9 also show that Duke University has received millions of dollars in research support from The Tobacco Institute. These facts seem to raise a question to potential conflicts of interest on the part of Dr Patz and his colleagues, and should be carefully considered by readers mulling over the results and conclusions of his manuscript. Author's Disclosures of Potential Conflicts of Interest The following author or their immediate family members have indicated a financial interest. No conflict exists for drugs or devices used in a study if they are not being evaluated as part of the investigation. Research Funding: Frederic W. Grannis Jr, International Early Lung Cancer Action Project. Other Remuneration: Frederic W. Grannis Jr, Medicsight Corporation. For a detailed description of these categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section of Information for Contributors found in the front of every issue.
REFERENCES
1. Patz EF Jr, Swensen SJ, Herndon JE II: Estimate of lung cancer mortality from low-dose spiral computed tomography screening trials: Implications for current mass screening recommendations. J Clin Oncol 22:2202-2206, 2004
2. Patz EF Jr, Rossi S, Harpole DH Jr, et al: Correlation of tumor size and survival in patients with stage IA non-small cell lung cancer. Chest 117:1532-1534, 2000
3. Patz EF Jr, Goodman PC, Bepler G: Screening for lung cancer: N Engl J Med 343:1627-1633, 2000
4. Patz EF Jr, Goodman PC: Low-dose spiral computed tomography screening for lung cancer: Not ready for prime time. Am J Respir Crit Care Med 163:813-814, 2001 5. Dammas S, Patz EF Jr, Goodman PC: Identification of small lung nodules at autopsy: Implications for lung cancer screening and overdiagnosis bias. Lung Cancer 33:11-16, 2001[CrossRef][Medline] 6. Heyneman LE, Herndon JE, Goodman PC, et al: Stage distribution in patients with a small (< 3 cm) primary non-small cell carcinoma: Implication for lung cancer screening. Cancer 92:3051-3055, 2001[CrossRef][Medline]
7. Patz EF, Black WC, Goodman PC: CT Screening for lung cancer: Not ready for routine practice. Radiology 221:587-591, 2001 8. Smith V: Radiologist: Lung-screen test smokers want is unproven, risky. Raleigh News & Observer, October 25, 2001 (Associated Press, WV) 9. The Tobacco Institute: The Tobacco Institute Industry Support of Biomedical Research 1986. http://legacy.library.ucsf.edu/tid/ueq91f00
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Copyright © 2005 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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