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Viewpoint |
1 From the Department of Medicine, Weill Medical College of Cornell University, New York, NY, the Department of Epidemiology and Biostatistics, and the Department of Medicine, McGill University, Montreal, Quebec, Canada (O.S.M.); and the Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10021 (C.I.H.). Received October 12, 2000; revision requested October 24; revision received December 29; accepted January 17, 2001. Address correspondence to C.I.H. (e-mail: chensch@med.cornell.edu).
The practicing radiologist today is well persuaded that earlier diagnosis of lung cancer can be achieved with traditional-type radiography and especially with modern computed tomography. The practitioner also is confident that intervention in the context of earlier diagnosis is more effective in preventing death due to this otherwise fatal disease. The practitioner is thus inclined to consider such screening in a high-risk person with suitably long life expectancy, especially when asked to provide it. On the other hand, the practitioner is aware of official recommendations against lung cancer screening, said to be based on demonstrated lack of effectiveness of traditional radiographic screening. Some researchers have expressed concerns about screening-associated "overdiagnosis." Given this dilemma, the critically thinking practitioner is concerned to understand the foundation of the official nihilism in evidence and reasoning, as she or he suspects that something may be seriously wrong in this. This article is an attempt to help such a practitioner in this effort—an effort that in the end is rewarded by the comforting realization that the nihilistic recommendations and hesitation-provoking cautions are founded on pseudoevidence and specious reasoning.
Index terms: Computed tomography (CT), utilization • Lung neoplasms, CT, 60.12111 • Lung neoplasms, diagnosis, 60.32 • Lung neoplasms, screening • Lung neoplasms, staging
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