X-Ray Lung Cancer Screening Does Not Prevent Deaths

A large government study has found that routine chest X-rays, once a common type of screening, do not prevent lung cancer deaths.

The study included more than 150,000 older Americans, with those who were smokers, former smokers and also those who had never smoked. Those who had four annual chest X-ray screenings were just as likely to die of lung cancer as participants who didn't have those tests.

The results from the National Cancer Institute-funded research confirm previous, smaller X-ray studies. They follow another big study from that institute favoring a newer, more sophisticated imaging test. That found fewer lung cancer deaths among current or former heavy smokers who had special CT imaging scans versus those who had chest X-rays.

CT scans provide much more detailed images than X-rays, and while no major medical group recommends any type of routine lung cancer screening, several are preparing new guidelines.
Screening refers to routine tests in people without symptoms; doctors say chest X-rays are still useful to help diagnose people with lung cancer symptoms, including a persistent cough or coughing up blood.

Dr. Manny Alvarez, senior managing health editor of said he agrees with the study’s findings.

“A typical chest X-ray does not have the quality to visualize early cancers as well as a CT scan would. X-rays are a very weak technology,” he said.

Chest X-ray screening for lung cancer was common decades ago, and some doctors continue to recommend it in smokers and former smokers. The new study results should put an end to that practice, said Robert Smith, director of cancer screening at the American Cancer Society.

The study was released online in the Journal of the American Medical Association on Wednesday, when it was presented at an American College of Chest Physicians meeting in Hawaii. The doctors' group is among those preparing new lung cancer screening recommendations.

The study's participants were aged 55 to 74 and were tracked for about 13 years. During that time, there were about 1,200 lung cancer deaths in participants who got X-rays and in those who got usual medical care. That's equal to about 14 deaths per 10,000 people each year.

Alvarez said he thinks this study should be a kickstart for a new policy on lung cancer screening.

“This study confirms findings from previous research. What needs to be done is to implement a policy utilizing CT scan technology that teaches hospital techs to use CT scans to pick up lung cancer,” Alvarez said. “It should be routinely implemented for patients in high risk categories like smokers and a those with a history of lung disease in their family.”

Lung cancer is the leading cancer killer; it will be diagnosed this year in about 220,000 people nationwide, and more than half that number will die from lung cancer, the cancer society estimates.

Less than 1 percent of never smokers will develop lung cancer in their lifetime. By contrast, about 18 percent of current smokers will get the disease by age 75; the risk is somewhat lower but not zero for former smokers, depending on how long ago they quit, said Dr. Christine Berg, the study's senior author and chief of the National Cancer Institute's early detection research group.

"We were really hoping chest X-rays might be beneficial," partly because they are relatively inexpensive — about $60 versus hundreds and sometimes thousands of dollars for CT scans, Berg said.

But Smith said the study shows routine chest X-ray screenings in healthy people without symptoms are "a waste of time," plus they can lead to false-positive results that may lead to invasive and potentially harmful tests.

That independent group, which advises the U.S. government, concluded in 2004 that there was no evidence to support any method of routine lung cancer screening in people without symptoms, including X-rays and CT scans.

Because CT scans also can yield false positive results, it is unlikely any group will recommend them for screening nonsmokers.

The Associated Press contributed to this report.