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‘State lung cancer screening will raise false positive diagnoses’
  • By Kim Eun-young
  • Published 2019.07.03 15:38
  • Updated 2019.07.03 15:38
  • comments 0

The government has decided to add lung cancer to the state cancer screening from July, but experts say it could do more harm than good.

Excessive Diagnosis Prevention Society held a news conference at the Press Center in Seoul, Wednesday, claiming that the government-supported lung cancer screening will not reduce smokers’ mortality and expose healthy people to potential risks.

Lee Jung-kwon, president of the society and a professor at the Family Medicine Department of Sungkyunkwan University School of Medicine, said it was difficult to expect a reduction in smokers' mortality from lung cancer screening, even when applying all the available clinical outcomes of lung cancer screening.

“It will rather mass-produce false positive cancer patients,” he said. “The government says the screening will lower lung cancer-caused mortality by 20 percent, but it is absurd logic. With the screening, the chance of smokers dying of lung cancer goes down from 5 percent to 4 percent. They calculated the 1 percentage point difference into a 20 percent reduction.”

Lee Jung-kwon (center), president of Excessive Diagnosis Prevention Society and a professor at the Family Medicine Department of Sungkyunkwan University School of Medicine, speaks during a news conference in Seoul, Wednesday.

Lee worried that healthy patients could suffer from subsequent risks after unnecessary lung cancer screening.

“Patients with benign nodules and overdiagnosis suffer tremendous damage because they have to go through unnecessary examinations, surgery, and even cancer treatment that they would not have if they hadn’t received lung cancer screening,” Lee said.

According to Lee, lung cancer screening has a high false-positive rate. The screening exposes healthy people to additional evaluations, biopsy, and even surgery. “In rare cases, they have to brace for death,” he said.

The society criticized the government for pushing lung cancer screening as a national policy while evidence was lacking to prove that the testing could lower lung cancer-caused mortality.

Korea is the only country to mandate lung cancer screening under state policy, it said.

Professor Shin Sang-won of the Oncology Internal Medicine Department at Korea University College of Medicine said out of 1,000 people who received lung cancer examinations, only 40 were confirmed as lung cancer patients. Among the 40, seven was overly diagnosed with lung cancer and died of other diseases, he said.

“Most smokers die of other cancer or chronic obstructive pulmonary disease, rather than cardiovascular disease or lung cancer. High-risk smokers’ lung cancer-caused mortality is only 5 percent,” Shin said.

Other countries, including Japan, Europe, and China, have long researched on lung cancer screening but no nation pursues it as a government policy, he said.

“As of 2018, Korea was the only country in the world to mandate state-supported lung cancer screening,” he added.

Lee Jae-ho, a professor at the Family Medicine Department of Catholic University of Korea College of Medicine, also said the government screening of lung cancer lacked a scientific basis.

Deciding to go ahead with the screening, based on the results of the pilot screening program in 2017 and 2018, will create “significant side effects,” he said.

“The pilot project was conducted before the implementation of the policy without a control group for two years. The scope of the interpretation of the result is minimal, which is insufficient as a scientific basis for the validity of the state lung cancer screening,” Lee of the Catholic University of Korea said.

Even medically advanced countries hesitate to include lung cancer screening in state cancer examinations because of the concern for its side effects, he said.

“The government did not provide any responsive measures for psychological, physical, and financial damage to falsely diagnosed cancer patients who have to undergo tests for a confirmed diagnosis,” Lee said.

Considering that 18-67 percent of early lung cancer discovered by low-dose lung CT scan is presumed to be overdiagnosed, it is questionable whether the screening is effective, he added.

State lung cancer screening could also exacerbate the problem in the medical delivery system.

“It will make primary care worse. Patients who used to receive treatments for chronic diseases at a near clinic will have to visit a large hospital for lung cancer screening. If they have to undergo routine follow-up exams of pulmonary nodules found on a CT scan at the large hospital, the patients won’t visit a near clinic anymore,” Lee said.


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