“Lung cancer screening is a great example of the problem,” says the former chief medical and scientific officer for the American Cancer Society in this third of four-part video series.
Otis Brawley’s reputation precedes him. But he says that what people say isn’t quite true.
“I was sometimes categorized as anti-screening. I am not. I am against inappropriate screening. And I am for applying science,” Brawley said in a recent video interview with Managed Healthcare Executive® editors Briana Contreras and Peter Wehrwein.
Brawley, M.D., now a professor of oncology and epidemiology at Johns Hopkins, has recently joined the Managed Healthcare Executive’s editorial advisory board. As chief medical and scientific officer for the American Cancer Society from 2007 to 2018, Brawley went against the grain by raising questions cancer screening.
“Yes,” he said in the MHE interview, “we are still overscreening. But it is not as bad as it once was, especially in prostate cancer.” And Brawley has a high opinion of the United States Preventive Services Task Force (USPSTF) , which issues screening guidelines; he said the task force applies science “very, very well.”
But the USPSTF recommended lung cancer screening for people with a history of heavy smoking in 2013, and it is considering an update that would broaden the recommendation so even more people would be considered candidates for lung cancer screening. Brawley is not shy about expressing his reservations: “Lung cancer screening is a great example of the problem,” he told Contreras and Wehrwein.
Brawley noted that the decisive trial for lung cancer screening was done at 30 of the country’s finest hospitals. Furthermore, he says the recommendations — he was speaking generally not in specific reference to the USPSTF recommendations — come with important qualifications: that the screening be done at a facility where the personnel and equipment can do the low-dose CT screening well and that the people being screened understand risks and benefits well.
“I worry about people (getting screened) in nonacademic settings. I worry about people in rural settings. Is the benefit-to-harm ratio for lung cancer screening going to be the same in the nonacademic setting”
Brawley also sees hospitals as leaping at the chance to provide a new lung cancer screening to the detriment of other programs.
“Unfortunately there are some hospitals that are shutting down navigator programs that would keep women in breast cancer treatment that would ultimately save more lives in order to establish lung cancer screening programs, which are sexy and might bring more prestige to the hospital, and maybe more money.”
Unnecessary care and tests accentuate healthcare disparities, in Brawley’s view. “When we do things in medicine that don’t work,we hurt people. We hurt not just the people who are getting the test or the treatment that should not be sued. We are also hurting other peoplewho need the hospital, who are crowded out of the hospital and can’t get the services they need.”