Benefits of CT lung scan for smokers is uncertain

medical matters

December 22, 2006|By Judy Foreman

Who should be screened for lung cancer with the new, low-dose CT scans?

It's a tough call because doctors disagree and insurance doesn't pay for it, so if you do opt for this noninvasive test, you'll be paying out of pocket -- about $300.

In October, the New England Journal of Medicine published a study of more than 30,000 current and former smokers and found that screening, which can catch lung cancers very early, at Stage I, was linked to a projected 88 percent, 10-year survival rate if patients were treated promptly with surgery.

This is much better than the usual survival rates for lung cancer. According to American Cancer Society figures, the survival rate at five years is only 15.5 percent, though this is for lung cancer patients at all stages of disease, not just early cancers.

Most lung cancer is caught late because earlier cancers cause few noticeable symptoms.

At first glance, the implication of the new study seems a no-brainer: Get screened if you're a current or former smoker who smoked at least half a pack a day for years.

But it's not that simple. In part because it had no control group, the study "cannot answer the question of whether screening reduces deaths from lung cancer," said Dr. Phillip Boiselle, director of thoracic surgery at Beth Israel Deaconess Medical Center in Boston. "You can only answer that question if you do a randomized controlled trial, in which half the participants undergo the screening test being studied and the other half do not."

A different, continuing study called NLST (National Lung Screening Trial) should be able to answer the question of whether CT screening saves lives, but those results won't be available until 2009 at the earliest.

There are also risks to CT screening, said Dr. Michael Thun, who heads epidemiological research for the American Cancer Society. Among other things, the test is so sensitive that it can pick up nodules that might not be life-threatening cancer. That could result in unnecessary surgery, with its risks of bleeding, infection and anesthesia.

So here's my take: If I were an insurance company executive, I'd say CT screening is not ready for prime time. But if I were a smoker, I'd quit if I hadn't already, then talk to my doctor about getting tested. The new study, though not perfect, is too good to ignore.

Can badly fitting shoes damage feet?

Yes, and a new study published this fall in the Journal of the American Podiatric Medical Association, suggested that most people wear the wrong size shoe.

The study, which involved 440 veterans, almost all male, found that only 25 percent of participants wore correctly sized shoes.

Men with diabetes -- which can lead to foot infections and amputations -- were five times as likely as others to have poorly fitting shoes. This is troubling because people with diabetes often have poor nerve sensation in the feet and don't notice cuts and ulcers that can become infected.

One reason so many people wear the wrong size shoes, the study suggested, is that patients with loss of sensation cannot tell when trying on shoes whether they are too tight. In addition, many people have one foot that is longer than the other, and unless shoes are fitted properly to the longer foot, the shoe for that foot will be too tight.

At a minimum, badly fitting shoes can cause corns and calluses -- protective layers of dead skin caused by friction of bone against shoes, said Dr. Joseph Caporusso, a podiatrist from McAllen, Texas, and chairman of public education and information for the podiatric group.

Poorly fitted shoes can also exacerbate hammertoes, a condition in which the toes are bent into a clawlike position. Bunions -- misaligned big toe joints that can become swollen and tender -- tend to run in families, but the tendency can be aggravated by too-narrow shoes, he said.

High heels, which throw the weight toward the front of the foot, can cause the Achilles tendon at the back of the ankle to shorten and disrupt the mechanics of walking, said Dr. Peter Paicos Jr., a podiatrist and associate medical director of the wound healing center at Winchester (Mass.) Hospital.

A shoe is supposed to be "a protective container," Paicos said. "But we spin fashion into it, so that changes what the container does."

Badly fitting shoes may not pose a serious problem in young people, he added, but in older people who may already have trouble walking, they can make a bad situation worse.

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