[ RadSafe ] CT vs. X-Ray for reduction of Cancer Death

[George Stanford]

Gary:
      Right on!
      --  George

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

At 04:41 PM 11/7/2010, garyi at trinityphysics.com wrote:
Hi Sandy,

I will be devil's advocate.

RE CT as a cost effective Ca preventive, here is a back of the 
envelope, per person
estimate.  Assume at least 100 patients per week (200 is doable), 50 
wks per yr, 4 yr scanner
lifetime (a conservative estimate).  That's 20,000 scans for every 
scanner.  Assume the
scanner costs $1e6.  That would be $50 per person for each 
scan.  Throw in another $50 per
person to make the venture profitable.  Voila!  For $100/yr, reduce 
your risk of lung Ca
mortality by 20% and your overall mortality risk by 7%.  If (its a 
big if, I know) it turns out that
annual CT scans do significantly reduce cancer mortality, and if I'm 
approximately right about
the economics, then new CT clinics would spring up like mushrooms to 
meet demand.
Haha, maybe the study authors are quietly buying up CT stocks now.  :)

But it does seem economical, and I haven't even considered the 
savings due to cancer
treatments that are no longer needed, or the savings due to prolonged 
productivity of those
who dodge the Ca bullet.  There's also the advantage of dying from 
something that is often
quick, like stroke or heart attack, instead of lingering painfully on 
your way to death.

One test that should be applied to the existing NLST cohort is Ca 
incidence instead of just
mortality: did the CT screened group have significantly lower 
incidence of lung cancer than
the chest x-ray group?  If so, it would certainly support the idea of 
CT scans as a Ca
prophylactic.

It seems almost that people are afraid to ask some questions.

 > The notion that everyone would benefit from a higher dose of
 >  radiation in my opinion is not acceptable, nor is there evidence
 >  that there is any positive benefit. The risks are
 >  well-known and to ignore the known facts cannot be ignored.

I think you mean "not proven" instead of "not acceptable".  Yes, if 
the data show that the 20%
is due only to early detection, then I agree with you.  I merely 
think we should find out what
the data show.  Simply assuming that hormesis can not play a role in 
the study results would
be a lamentable case of jumping to conclusions.  Historically, lung 
cancer has been difficult
to treat, and I would be surprised if the huge difference in 
mortality can be wholly due to early
detection.

-Gary Isenhower


On 7 Nov 2010 at 12:22, Perle, Sandy wrote:

A reduction of any illness/disease through the use of technology does 
not imply that every
individual in the entire population should undergo that 
application/procedure with the stated
goal of reducing the long-term probability of said individual to 
detect and minimize the effects
of that illness/disease from occurring. There are many preventative 
exams that can be
conducted today for age specific, genetically prone individuals, to 
be tested, at an economical
cost. Just considering the cost of CT scans and the economic effect 
if everyone was to
receive this exam, would be not cost effective. Another point is the 
assumption that somehow
this dose may be a positive outcome is simply not acceptable. 
Personally I still am of the
opinion that exams involving either radiological or nuclear medicine 
should only be utilized
where there is a distinct requirement for the exam to diagnose an 
illness or confirm the
diagnosis. The notion that everyone would benefit from a higher dose of r
  adiation in my opinion is not acceptable, nor is there evidence 
that there is any positive
benefit. The risks are well-known and to ignore the known facts 
cannot be ignored.

Regards,

Sandy
____________________
Sander C. Perle
President
Mirion Technologies
Dosimetry Services Division
2652 McGaw Avenue
Irvine, CA 92614

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