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The International Early Lung Cancer Action Program (I-ELCAP) Study

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

Arch Intern Med. 2007;167(21):2289-2295.

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.

Author Affiliations: VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont, and the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, New Hampshire (Drs Welch, Woloshin, and Schwartz); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, and Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Dr Gordis); Nordic Cochrane Center, Rigshospitalet, Copenhagen, Denmark (Dr Gøtzsche); University of North Carolina School of Medicine, Chapel Hill (Drs Harris and Ransohoff); and Office of Disease Prevention, National Institutes of Health, Bethesda, Maryland (Dr Kramer).

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