Article and Video CATEGORIES

Cancer Journey

Search By

Dr. Jack West is a medical oncologist and thoracic oncology specialist who is the Founder and previously served as President & CEO, currently a member of the Board of Directors of the Global Resource for Advancing Cancer Education (GRACE)


American Academy of Family Physicians Denies Utility of Chest CT Screening: A Harmful Slight to the Lung Cancer World
Howard (Jack) West, MD

This week, the American Academy of Family Physicians (AAFP) elected to not follow the lead of the more influential US Preventive Services Task Force (USPSTF), which previously reviewed the information on chest CT screening for high risk patients and recommended it, and said that there is insufficient evidence to support chest CT screening.

The specific arguments were that, when the evidence from the National Lung Screening Trial is combined with some other, less definitive studies, there wasn't a clear enough signal of benefit to support chest CT screening, per Dr. Doug Campos-Outcalt, MD, MPA, the AAFP liaison to the USPSTF.

"People need to understand that their life expectancy could be extended by this, but on the other hand, their life expectancy could be shortened by it," Dr. Campos-Outcalt said in a statement. "If they're currently smoking, a better thing to do by far is to stop smoking."

I would challenge Dr. Campos-Outcalt to show us the evidence that their life expectancy could be shortened by screening, as his statement implies that the evidence is of equal strength for either concept. In fact, there is exponentially greater evidence that people can have their lives extended by screening than that it is harmful, though I am circumspect enough to recognize that there are limitations in how screening might be best applied.

At the same time, framing this issue as if there is some choice between continuing to smoke and screening for lung cancer might charitably be called asinine. Yes, smoking cessation saves lives as well, but lung cancer screening doesn't preclude this in any way and can even serve as an ideal point for initiating a new effort at smoking cessation for patients being screened who continue to smoke.

My view is that this declaration is a testament that you can interpret data selectively to support whatever preconceived biases you want. That the AAFP would say that a series of less well conducted, smaller studies that support the same conclusion to a lesser degree somehow refutes the more definitive conclusions of the NLST is befuddling, and it is telling that so many other professional societies, including the very evidence-based USPSTF, has reviewed these data and reached the opposite conclusion.

Unfortunately, I'm afraid that the AAFP stand on this complex issue likely reflects an unenlightened nihilism and a reluctance to recognize data that require changing practice. I suspect that the economic implications of screening are more of a driver here than an honest, balanced assessment of the actual evidence.

I can only hope that the USPSTF judgment outweighs the dismissal by the AAFP, or that people question the judgment of family practitioners here, who are making a unilateral decision to let potentially preventable lung cancers take the lives of people as they quibble about the lack of sufficient evidence -- similar to the arguments used by the tobacco industry that challenged the quality of the data supporting a link between smoking and lung cancer.

Next Previous link

Previous PostNext Post

Related Content

Blood Cancer OncTalk
In this series of videos, Dr. Aaron Goodman chairs the discussion along with speakers Drs. Tycel Phillips, Sridevi Rajeeve, Marco Ruiz and Alankrita Taneja.  Topics include:
View the full Targeted Therapies in Lung Cancer Patient forum from 2023 in YouTube and embedded here! 

Forum Discussions

Hi Amber, Welcome to Grace.  I'm so sorry you're going through this scare.  It could be a recurrence.  It also is as likely to be the contrast creating a better view. ...

Hi Blaze,


As much as I hate to say it, Welcome back Blaze.  It sounds like you're otherwise feeling good and enjoying life which is a wonderful place to be. ...

Waiting for my appointment with oncologist this morning. Thank you for the response. It helps. <3

It sounds like you’re thinking of this in a very appropriate way. Specifically, it sounds like the growth of the nodule is rather modest, though keep in mind that the change...

Hi and welcome to GRACE.  I'm sorry your mom is having this difficulty.  An indwelling catheter is used when the pleura space continually fills and the catheter is always there to...

Recent Comments

Hi Amber, Welcome to Grace. …
By JanineT GRACE … on
Could you
By Maeve785 on
It sounds like you’re…
By Dr West on
Thank you Janine
By blaze100 on