New Lung Screening Benefits: Vindication For A Controversial Advocate?

Dr. Claudia Henschke has been a key backer of CT scans to screen for lung cancer
Dr. Claudia Henschke has been a key backer of CT scans to screen for lung cancer

But now, with a huge federal study showing the benefits of such screening, doesn't it seem like much of what the researcher, Dr. Claudia Henschke, has said is turning out to be true?

Back then, not only did The Times take Dr. Henschke, now a professor of radiology at Mount Sinai School of Medicine, to task for accepting tobacco money for her research, the piece also questioned the research itself. Here's the 2008 story, under the headline, "Cigarette Company Paid For Lung Cancer Study:"

...the disclosure that Dr. Henschke’s work was in part underwritten by grants from a cigarette maker will undercut those efforts, prominent cancer researchers said. “She’s the biggest advocate for widespread spiral CT screening,” said Dr. Paul Bunn, a lung cancer expert and executive director of the International Association for the Study of Lung Cancer. “And now her research is tainted.”

Since 1999, Dr. Henschke has asserted that annual CT scans of smokers and former smokers would detect lung cancer when tumors are small enough to be cured, preventing as many as 80 percent of the 160,000 deaths a year from lung cancer, by far the biggest cause of cancer deaths in the United States.

Her 2006 study said that, after screening 31,567 people from seven countries, CT scans uncovered 484 lung cancers, 412 of them at a very early stage. Three years later, most of those patients were still alive, and she projected that 80 percent would be alive after 10 years and assumed that they would have died without the screens.

Critics question both her survival projections and her assumption that all would have died without screening. Indeed, most in the cancer establishment say that Dr. Henschke has yet to prove her case. CT scans have radiation risks and sometimes detect cancers that would not have progressed, leading to risky procedures like biopsies and lung surgery when not needed.

To settle the dispute, the National Cancer Institute started in 2002 the $200 million National Lung Screening Trial comparing death rates among 55,000 people randomly assigned to have CT scans or chest X-rays. Results are not expected until 2010. Dr. Henschke has asserted that allowing hundreds of thousands of people to die in the meantime is unethical.

Bruce E. Johnson, MD, director, Lowe Center for Thoracic Oncology at Dana-Farber Cancer Institute is quoted on the Dana-Farber website saying the findings are profound: "This is very significant as it translates into 32,000 lung cancer patients whose lives could be saved each year. These results should prompt the medical community to bring the CT screening technology safely, and with acceptable risk, and cost to the American public." And the Reuters headline is: For Doctor Pushing Lung Screening, A Vindication. .

Indeed, Dr. Henschke, in an interview, said: "We always believed in our data, we've now screened over 53,000 people in the world. I'm just thrilled because there are so many lives that can be saved."

She says she followed all of her institution's policies when she accepted the tobacco money and that the tobacco company had no input into her data nor was given any special rights. "At that time, it was considered a great coup," she said. "In retrospect, could we have done it better? Sure. Now I always put it out there, and we always provide smoking cessation advice, and say that screening should include smoking cessation because it's a teachable moment."

She says she's gotten a lot of congratulations since the NCI report came out, including a message from a colleague whose wife just died of lung cancer. "He said, I wish I had known, my wife would be alive today."

But skeptics still abound. Dr. Jerome Kassirer, a professor at Tufts School of Medicine and an expert on ethics in medicine, says it's important to separate "conflicts of interest" from "bias." "When you take drug or tobacco money, you have a conflict of interest," he said in an interview. "But that doesn't necessarily mean you act on the conflict of interest - that's different from bias."

Still, Dr. Kassirer remains wary of any financial ties with a tobacco company. "Were Henschke's remarks about her research 2, 3 years ago biased? Perhaps," he says. "Is she still biased today? I don't know but I suspect so."

Moreover, Dr. Kassirer notes, the data from the trial have not yet been released, and it remains unclear which population might truly benefit from CT screening for lung cancer, what the cost might be, and what harms, including excessive radiation, might be associated with such widespread screening.

Here's a smart assessment of the coverage from Gary Schweitzer, on his Health News Review blog.

This program aired on November 5, 2010. The audio for this program is not available.

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Rachel Zimmerman Reporter
Rachel Zimmerman previously reported on health and the intersection of health and business for WBUR. She is working on a memoir about rebuilding her family after her husband’s suicide. 



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