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Hospital de Clínicas, University of Buenos Aires Buenos Aires, Argentina
Correspondence to: Hugo Esteva, MD, FCCP, Division Cirugia Toracica, Universidad de Buenos Aires, Cordoba 2351, Buenos Aires CP1120, Argentina; e-mail: hesteva{at}intramed.net.ar
To the Editor:
Medical academic journals are influential in physicians’ decision making all over the world. In the July 2002 issue of CHEST, Handy et al1 showed that the quality of life of patients is impaired 6 months after lung cancer resection. Another article2 and an editorial comment3 were critical of screening alternatives. Conversely, another article4 has shown the accuracy of helical CT scanning for the early detection of peripheral lesions, and another editorial5 properly has indicated the specific use and the economical interests that underlie screening.
After all this reading, should the practitioner deny surgery to his patients? Does it make sense to conclude that a patient’s quality of life is suboptimal 6 months after undergoing surgery when lung function and residual pain can still improve?
Historically, the Mayo Lung Project did not show a significant difference in survival between resected patients who had been tested for detection three times a year and their usual population of heavy smokers (control group) who were tested every year. In those days, Dr. Robert Fontana (personal communication; July 9, 1984) wrote me the following: "I deeply appreciate the data that you sent to me, and I agree with you completely. The data are impressive, particularly the overall resectability rate of approximately 15%. Our final figures concerning resectability in the Mayo Lung Project are now 32% for the control group. Nearly a third of the cancers in the control group were detected by chest radiograph films obtained during the evaluation of non-lung cancer complaints or during general medical examinations of men who had been heavy smokers. Of lung cancers detected in this way, 75% were resectable ‘for cure.’ Such cases constitute the majority of resectable cases in the control population. I believe that you have supplied the answer to the question of what would have happened to the patients in the control population had they not access to chest radiograph examinations."
There are important differences between studies involving large populations and the responsibility of each physician to the individual patient, the source of the physician’s duty and concern. So, I believe that, to date, the best indication for a high-risk patient is early endoscopic and/or CT scan detection of lesions. The patient will then be able to take the unique chance for a cure that only surgery can offer.
References
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