By Matthew Bin Han Ong
In a recent appearance on PBS, Claudia Henschke, a long-time advocate of CT screening for lung cancer, made an astonishing claim:
Screening could prevent 140,000 to 160,000 deaths from lung cancer annually in the U.S., she said in an interview posted on the PBS website Oct. 4.
This range—which at the low end is nearly 10 times higher than the next highest estimate—and at the high end actually exceeds the number of people who die of lung cancer each year by a few thousand, was cited in Henschke’s “sidebar” interview accompanying a broader story on coverage of preventive services in the Affordable Care Act.
In a recent appearance on PBS, Claudia Henschke, a long-time advocate of CT screening for lung cancer, made an astonishing claim:
Screening could prevent 140,000 to 160,000 deaths from lung cancer annually in the U.S., she said in an interview posted on the PBS website Oct. 4.
This range—which at the low end is nearly 10 times higher than the next highest estimate—and at the high end actually exceeds the number of people who die of lung cancer each year by a few thousand, was cited in Henschke’s “sidebar” interview accompanying a broader story on coverage of preventive services in the Affordable Care Act.
In the interview, Henschke doesn’t mention the findings of the National Lung Screening Trial, a large, NCI-sponsored randomized trial, which formed the foundation for the recent United States Preventive Services Task Force’s July 30 draft recommendation for lung screening.
“I think that some 70 to 80 percent of the people who develop lung cancer, their lives could be saved,” said Henschke, now a clinical professor of radiology and director of the lung screening program at Mount Sinai Hospital in New York. “Every year, it’s about 200,000; 200,000 people develop lung cancer, and you could potentially save 70 percent, plus or minus, of those lives.”
A transcript of the interview appears after the story.
According to the American Cancer Society, about 20 percent, or 12,250 lung cancer deaths http://www.ncbi.nlm.nih.gov/pubmed/23440730 can be averted per year in the U.S. among screening-eligible populations of current and former smokers—including those who quit within the past 15 years, are 55 to 74 years old, and had smoked at least 30 pack-years.
When extrapolated to include the number of people who die of lung cancer per year in the U.S.—or 158,081 in 2009, according to the CDC—the NLST estimate amounts to only 7.6 percent of averted deaths, a far cry from Henschke’s numbers.
Henschke’s critics agree that her work had, in fact, prompted NCI to launch the NLST (The Cancer Letter, Nov. 5, 2010).
Henschke appears in a package of PBS stories about the Affordable Care Act.
“I think that some 70 to 80 percent of the people who develop lung cancer, their lives could be saved,” said Henschke, now a clinical professor of radiology and director of the lung screening program at Mount Sinai Hospital in New York. “Every year, it’s about 200,000; 200,000 people develop lung cancer, and you could potentially save 70 percent, plus or minus, of those lives.”
A transcript of the interview appears after the story.
According to the American Cancer Society, about 20 percent, or 12,250 lung cancer deaths http://www.ncbi.nlm.nih.gov/pubmed/23440730 can be averted per year in the U.S. among screening-eligible populations of current and former smokers—including those who quit within the past 15 years, are 55 to 74 years old, and had smoked at least 30 pack-years.
When extrapolated to include the number of people who die of lung cancer per year in the U.S.—or 158,081 in 2009, according to the CDC—the NLST estimate amounts to only 7.6 percent of averted deaths, a far cry from Henschke’s numbers.
Henschke’s critics agree that her work had, in fact, prompted NCI to launch the NLST (The Cancer Letter, Nov. 5, 2010).
Henschke appears in a package of PBS stories about the Affordable Care Act.
Hannah Yi, a producer of the story, said the Oct. 5 television broadcast was vetted by the Department of Health and Human Services.
The PBS report states that the ACA requires Medicare and private insurers to include preventive services, but sources said this might not apply to coverage for lung CT screening if the USPSTF’s B-grade recommendation is finalized.
Peter Bach, a pulmonologist and health systems researcher at Memorial Sloan-Kettering Cancer Center, said:
“I’m not really sure which part of this story to note, whether it is that the PBS story shows a woman aged 82 being screened for lung cancer when no one recommends screening at that advanced age, or if I should focus on Dr. Henschke’s estimate that screening will prevent 10 to 20 times as many lung cancer deaths as anyone else projects, or that the story seems to be saying there is a provision in the Affordable Care Act that would trigger Medicare coverage of CT screening if it is recommended by the [USPSTF], when there is no such provision,” Bach said. “You pick.”
Henschke did not respond to an interview request from The Cancer Letter.
PBS Reporter is Henschke’s Colleague
The PBS report states that the ACA requires Medicare and private insurers to include preventive services, but sources said this might not apply to coverage for lung CT screening if the USPSTF’s B-grade recommendation is finalized.
Peter Bach, a pulmonologist and health systems researcher at Memorial Sloan-Kettering Cancer Center, said:
“I’m not really sure which part of this story to note, whether it is that the PBS story shows a woman aged 82 being screened for lung cancer when no one recommends screening at that advanced age, or if I should focus on Dr. Henschke’s estimate that screening will prevent 10 to 20 times as many lung cancer deaths as anyone else projects, or that the story seems to be saying there is a provision in the Affordable Care Act that would trigger Medicare coverage of CT screening if it is recommended by the [USPSTF], when there is no such provision,” Bach said. “You pick.”
Henschke did not respond to an interview request from The Cancer Letter.
PBS Reporter is Henschke’s Colleague
PBS reporter and Mount Sinai doctor Emily Senay interviews colleague Claudia Henschke (Source: PBS)
Henschke made the claim in an interview conducted by PBS reporter Emily Senay, who is also employed by Henschke’s institution.
Mount Sinai runs a well-promoted lung screening program, which is led by Henschke.
The PBS story comes at a time when, increasingly, staunch advocates of screening are defaulting to USPSTF’s recommendations. Notably, the Lung Cancer Alliance, a long-time political ally of Henschke, now recommends screening according to USPSTF guidelines.
“The little sidebar thing, honestly, it didn’t occur to me that—it was meant to be not controversial and just a little sidebar on lung cancer screening,” Senay said to The Cancer Letter. “It wasn’t meant to be anything big or related to the piece, and the thing that most people saw is the piece that we did on USPSTF.
“I know that there’s a lot of anger, there’s a lot of personal stuff—we try to stay out of all that with regards to Henschke,” said Senay, who is an assistant clinical professor of preventive medicine at Mount Sinai. “The piece is not about the value of CT screening, the piece is about USPSTF. That was not the focus of the piece.
“And obviously, if we did an extended piece on the value of lung CT screening, we would address all that, but we didn’t focus on that.”
The Cancer Letter contacted PBS for comment on Henschke’s claims, and on Senay’s reporting.
“I thought we did an inadequate job on our web piece, that it was posted too quickly, and with not enough thought, in a way that presented an incomplete and therefore potentially inaccurate picture of the thinking about these kinds of screenings to the public,” said Marc Rosenwasser, executive producer of PBS Newshour Weekend, which is based at WNET in New York City. “I thought one of the failures of the web posting is it didn’t put in the proper context these various findings about the success of the [lung CT screening].”
The web piece was corrected on Oct. 10.
“Within 12 hours of this coming to our attention, we’re going to have a much more complete posting, which will include contrary findings that place the significance of these [screenings],” Rosenwasser said to The Cancer Letter. “According to what other people are saying, unlike that particular doctor, [averting deaths through lung CT screening] might be successful 20 percent of the time, instead of 75 to 80 percent of the time.”
Henschke’s single-arm study was funded in part by the Foundation for Lung Cancer: Early Detection, Prevention & Treatment, a non-profit underwritten almost entirely by $3.6 million in grants from the Vector Group, parent company of the Liggett Group, which owns the Liggett Select, Eve, Grand Prix, Quest, and Pyramid cigarette brands. Henschke failed to disclose this in her papers (The Cancer Letter, March 28, 2008).
PBS: There Was No Conflict of Interest
Senay was not identified as a colleague of Henschke’s in the PBS original web posting.
The description initially read: “Special correspondent Dr. Emily Senay speaks with Dr. Claudia Henschke of Mount Sinai Hospital, a leading expert in lung cancer screenings.”
Senay acknowledged that her affiliation with Mount Sinai should have been noted. PBS knew she and Henschke work for the same institution, Senay said.
“I don’t know how that got left off—I think because when they cut it to make a little box online, the fact that both of us work for Mount Sinai was lost in the text,” Senay said.
PBS determined that there was no conflict of interest, Rosenwasser said.
“When we commissioned the piece, we had an extensive discussion with the correspondent about what her relationship was with [Henschke], because it obviously occurred to us that there was a possible appearance of a conflict of interest, and we determined that there was none, based on how limited the relationship was,” Rosenwasser said. “We had every intent, if Henschke made the broadcast piece, of disclosing it to the viewer.”
Henschke appeared in the main television broadcast piece, but, according to Rosenwasser, there was no disclosure of conflicts of interest, because Henschke was not interviewed.
“So again, if [Henschke] had been in the piece on television, it’s a 100 percent certainty that Emily’s affiliation with Mount Sinai would have been disclosed—we owe it to the viewer to disclose that,” Rosenwasser said.
PBS initially accounted for the lack of disclosure in the web posting by revealing Senay’s affiliation with Mount Sinai, after an Oct. 8 HealthNewsReview.org blog post titled, “Ethics problem: physician-journalists interview colleagues without disclosing conflict,” drew attention to the issue.
This is a weak attempt at disclosure, and PBS has a responsibility beyond that, said Gary Schwitzer, publisher of HealthNewsReview.org and adjunct professor in the School of Public Health at the University of Minnesota.
“What is PBS’s obligation to explain the implications of this to their audience?” Schwitzer asked. “And that is, as I started to hint at in my blog post: There is institutional honor and glory, which is promoted when you have two employees playing kissy-face in what’s supposed to be a journalistic setting, which is supposed to be independently vetting claims, not throwing up softballs to one of your friendly colleagues.”
Money, too, is at stake when a singular institution’s screening program is so directly promoted by a well-known, public news organization, Schwitzer said.
“[The PBS reporter] is unquestioningly promoting screening, which is not chump change, and about which there are still questions about the evidence for a general audience,” Schwitzer said to The Cancer Letter. “So it just begs a lot more scrutiny on the story itself, a lot more clear and explanatory disclosure.
“And I will acknowledge, there are times when you are a physician-journalist, when your hands are tied and you really must interview someone who is one of your institutional colleagues, you need to do a lot more than just throw up a line after somebody points out that you’ve made a misstep, a line that very weakly hints at the fact that there is a conflict here.
“It should raise all sorts of questions about credibility,” Schwitzer said. “But I’m afraid we have numbed the audience into accepting conflicted messages to such a degree that it probably doesn’t have any impact, and that disclosure probably doesn’t have any impact.
“If anyone could even perceive a conflict in what you’re doing as a journalist, you have to avoid that,” Schwitzer said. “PBS was so far from meeting that standard.
“I don’t think these are academic questions,” Schwitzer said. “These are really vital questions of public understanding of how deep and rampant conflicts of interest may be, and the impact they may have on our understanding of technology assessment, of the tradeoffs between harms and benefits in healthcare interventions of any type, including screening tests.”
Responding to questions from The Cancer Letter, PBS said they would expand the COI disclosure statement on the Henschke post.
“We are fixing our web piece, and we want to be fair, accurate and balanced, and I don’t think we did that good a job on the web posting,” Rosenwasser said.
The new disclosure statement notes that Senay, a preventive medicine assistant clinical professor, and Henschke, the head of Mount Sinai’s lung screening program, have never worked together in any capacity.
“The statement is correct,” Senay said. “I do not refer nor have I ever referred patients to Dr. Henschke.”
The statement reads:
“Special correspondent Dr. Emily Senay speaks with Dr. Claudia Henschke of Mount Sinai Hospital. Dr. Henschke is a leading expert in lung cancer screenings.
“Dr. Senay is an Assistant Clinical Professor in the Department of Preventive Medicine at Mount Sinai, and Dr. Henschke is a Professor of Radiology and heads the Lung and Cardiac Screening Program. Other than both being employees of Mount Sinai, they do not work together in any capacity now, nor have they in the past.
“The USPSTF recently gave a high recommendation to low dose CT scans for lung cancer. If the task force finalizes the grade for this screening, healthcare insurers will be required by the Affordable Care Act to cover it fully. Their conversation starts with that premise.”
Rosenwasser said he has questioned Senay about her relationship with Mount Sinai, and takes her word for it.
“In other words, you should take it as a given that we start every day by trying to be honorable in our profession, and so everything follows from trust, everything follows from credibility,” Rosenwasser said. “Our rule here is, if it occurs to us that there is a problem, it’s a problem. So we try to address these things both before we commission a piece, and in the course of reporting a piece.”
Senay: “Who Pays for You?”
PBS did not have to assign a physician-journalist to a story involving one of her colleagues, Schwitzer said.
“If PBS takes one of their other solid journalists, the story wouldn’t even require anyone with medical or health science journalism background,” Schwitzer said.
Rosenwasser said Senay was more important than most correspondents because she’s “actually an expert on a couple different levels.”
“She’s covered many issues related to, obviously, medicine, but also, she did at least one long piece on the Affordable Care Act about hospital readmissions,” Rosenwasser said. “My take is that she understands policy and she’s a doctor, so she’s a viable contributor on that basis—she has medical expertise and policy expertise.”
In a conversation with this reporter, Senay brushed aside the importance of PBS’s web posting, saying her interview with Henschke wasn’t about the value of CT screening.
“My feeling is, you are probably the only person who watched that interview,” Senay said. “We didn’t get into the details and the values of CT screenings, because that is kind of beside the point.
“The little piece that I know that you guys are upset about is [Henschke] giving her numbers—we did not get to include her in the television piece,” Senay said. “You can address it, you can write online that you disagree specifically with her estimations.
“I think this is like an inside-baseball thing, and you have a problem with Henschke’s estimations.”
Senay ended the interview by questioning The Cancer Letter’s motivations for pursuing this story.
“Who pays for you? I mean, where do you get your funding?” Senay asked. “How much pharma money supports your newsletter? And which pharmas advertise in your newsletter?”
The PBS Interview in Question
A transcript of the Senay’s interview with Henschke:
Emily Senay: Is it the idea that the government is paying for it and health insurance will have to pay for it that has people upset about CT lung screening?
Claudia Henschke: No, I think there are some people who just don’t believe in screening. They don’t believe in doing something to people who don’t have symptoms.
ES: Can you quantify how many lives would be saved if the program went forward and Obamacare covered it, and they followed the exact protocol?
CH: I think that some 70 to 80 percent of the people who develop lung cancer, their lives could be saved.
ES: And how many people in the U.S. develop lung cancer every year.
CH: Every year, it’s about 200,000; 200,000 people develop lung cancer, and you could potentially save 70 percent, plus or minus, of those lives.
ES: How did you get into screening for lung cancer in healthy people?
CH: Well, I’m a chest radiologist, so in chest, there are several important diseases. Lung cancer is one of them, pulmonary embolism is another one, and as we started researching and as we saw more CT scans becoming available and seeing little nodules, we thought we should explore the possibility of CT screening.
And there was no database at that time in the early 1990s, so everybody, nobody really knew on what basis they were making follow-up recommendations.
ES: What took so long to screen for what’s the number one killer of both men and women?
CH: The CT screening we started in the early 1990s, but we didn’t complete that study until 1999. And at that point, yes, there was a lot of interest because it was like people described it as a shot heard around the world.
That first study showed we compared chest X-ray and CT on 1,000 people, and we showed that CT finds them early, and over 80 percent were in early stage, and therefore highly curable, and the chest X-ray really didn’t find very many of the cancers.
ES: Was there a bias against developing a screening tool for smokers?
CH: Patients would come, people would come and participate and be very happy about the results, and they would go back to their friends and their friends would say, “Oh, well, I would be dead, I’d rather not know. I’d be dead in one year. Well, that’s true for late-stage cancer. That is true for lung cancer that you don’t find early. Most of them die within a year or year and a half. But if you find it early, that they’re highly curable—you can cure small, early-stage, well over 90 percent of them.
ES: So what is the controversy? Why is there any question about the value of screening high-risk smokers for lung cancer?
CH: Any screening program has benefits and potential harms. When you do CT scans, you find many nodules. Today, the scanners are so good you find almost everybody has a nodule. You don’t want to work up those nodules, so you have to have very careful protocols on how to do it, and that’s how we present it in our first paper. People congratulated us because they said, “You told us how to work up, which ones to work up, and how to do it.”
ES: What about people who say, “Gosh, you’re doing all this exploring, and you’re going to wind up giving people procedures who don’t need the procedure, it’s going to cost a lot of money, it’s going to create anxiety—isn’t that the downside of screening?”
CH: That is the potential downside. So you have to have a very carefully worked-out protocol on who needs further work up, you need to do the imaging at low dose, you need to carefully determine who should have surgery.
But if you follow the steps that we suggest, then really almost all of the people who go to surgery have lung cancer, and you still find it early, you just have to carefully, methodically work out that algorithm.
It makes me feel very happy that people can get the benefit that lives can be saved. I have seen the individuals that we’ve screened and they have productive lives. They say, “I’ve been able to see my grandchildren grow, I’ve seen my son married and all of those things I wouldn’t have seen if I hadn’t gone through your program.” [Henschke begins tearing up.]
So to have that being made available to everybody who is at high-risk is very touching.
Mount Sinai runs a well-promoted lung screening program, which is led by Henschke.
The PBS story comes at a time when, increasingly, staunch advocates of screening are defaulting to USPSTF’s recommendations. Notably, the Lung Cancer Alliance, a long-time political ally of Henschke, now recommends screening according to USPSTF guidelines.
“The little sidebar thing, honestly, it didn’t occur to me that—it was meant to be not controversial and just a little sidebar on lung cancer screening,” Senay said to The Cancer Letter. “It wasn’t meant to be anything big or related to the piece, and the thing that most people saw is the piece that we did on USPSTF.
“I know that there’s a lot of anger, there’s a lot of personal stuff—we try to stay out of all that with regards to Henschke,” said Senay, who is an assistant clinical professor of preventive medicine at Mount Sinai. “The piece is not about the value of CT screening, the piece is about USPSTF. That was not the focus of the piece.
“And obviously, if we did an extended piece on the value of lung CT screening, we would address all that, but we didn’t focus on that.”
The Cancer Letter contacted PBS for comment on Henschke’s claims, and on Senay’s reporting.
“I thought we did an inadequate job on our web piece, that it was posted too quickly, and with not enough thought, in a way that presented an incomplete and therefore potentially inaccurate picture of the thinking about these kinds of screenings to the public,” said Marc Rosenwasser, executive producer of PBS Newshour Weekend, which is based at WNET in New York City. “I thought one of the failures of the web posting is it didn’t put in the proper context these various findings about the success of the [lung CT screening].”
The web piece was corrected on Oct. 10.
“Within 12 hours of this coming to our attention, we’re going to have a much more complete posting, which will include contrary findings that place the significance of these [screenings],” Rosenwasser said to The Cancer Letter. “According to what other people are saying, unlike that particular doctor, [averting deaths through lung CT screening] might be successful 20 percent of the time, instead of 75 to 80 percent of the time.”
Henschke’s single-arm study was funded in part by the Foundation for Lung Cancer: Early Detection, Prevention & Treatment, a non-profit underwritten almost entirely by $3.6 million in grants from the Vector Group, parent company of the Liggett Group, which owns the Liggett Select, Eve, Grand Prix, Quest, and Pyramid cigarette brands. Henschke failed to disclose this in her papers (The Cancer Letter, March 28, 2008).
PBS: There Was No Conflict of Interest
Senay was not identified as a colleague of Henschke’s in the PBS original web posting.
The description initially read: “Special correspondent Dr. Emily Senay speaks with Dr. Claudia Henschke of Mount Sinai Hospital, a leading expert in lung cancer screenings.”
Senay acknowledged that her affiliation with Mount Sinai should have been noted. PBS knew she and Henschke work for the same institution, Senay said.
“I don’t know how that got left off—I think because when they cut it to make a little box online, the fact that both of us work for Mount Sinai was lost in the text,” Senay said.
PBS determined that there was no conflict of interest, Rosenwasser said.
“When we commissioned the piece, we had an extensive discussion with the correspondent about what her relationship was with [Henschke], because it obviously occurred to us that there was a possible appearance of a conflict of interest, and we determined that there was none, based on how limited the relationship was,” Rosenwasser said. “We had every intent, if Henschke made the broadcast piece, of disclosing it to the viewer.”
Henschke appeared in the main television broadcast piece, but, according to Rosenwasser, there was no disclosure of conflicts of interest, because Henschke was not interviewed.
“So again, if [Henschke] had been in the piece on television, it’s a 100 percent certainty that Emily’s affiliation with Mount Sinai would have been disclosed—we owe it to the viewer to disclose that,” Rosenwasser said.
PBS initially accounted for the lack of disclosure in the web posting by revealing Senay’s affiliation with Mount Sinai, after an Oct. 8 HealthNewsReview.org blog post titled, “Ethics problem: physician-journalists interview colleagues without disclosing conflict,” drew attention to the issue.
This is a weak attempt at disclosure, and PBS has a responsibility beyond that, said Gary Schwitzer, publisher of HealthNewsReview.org and adjunct professor in the School of Public Health at the University of Minnesota.
“What is PBS’s obligation to explain the implications of this to their audience?” Schwitzer asked. “And that is, as I started to hint at in my blog post: There is institutional honor and glory, which is promoted when you have two employees playing kissy-face in what’s supposed to be a journalistic setting, which is supposed to be independently vetting claims, not throwing up softballs to one of your friendly colleagues.”
Money, too, is at stake when a singular institution’s screening program is so directly promoted by a well-known, public news organization, Schwitzer said.
“[The PBS reporter] is unquestioningly promoting screening, which is not chump change, and about which there are still questions about the evidence for a general audience,” Schwitzer said to The Cancer Letter. “So it just begs a lot more scrutiny on the story itself, a lot more clear and explanatory disclosure.
“And I will acknowledge, there are times when you are a physician-journalist, when your hands are tied and you really must interview someone who is one of your institutional colleagues, you need to do a lot more than just throw up a line after somebody points out that you’ve made a misstep, a line that very weakly hints at the fact that there is a conflict here.
“It should raise all sorts of questions about credibility,” Schwitzer said. “But I’m afraid we have numbed the audience into accepting conflicted messages to such a degree that it probably doesn’t have any impact, and that disclosure probably doesn’t have any impact.
“If anyone could even perceive a conflict in what you’re doing as a journalist, you have to avoid that,” Schwitzer said. “PBS was so far from meeting that standard.
“I don’t think these are academic questions,” Schwitzer said. “These are really vital questions of public understanding of how deep and rampant conflicts of interest may be, and the impact they may have on our understanding of technology assessment, of the tradeoffs between harms and benefits in healthcare interventions of any type, including screening tests.”
Responding to questions from The Cancer Letter, PBS said they would expand the COI disclosure statement on the Henschke post.
“We are fixing our web piece, and we want to be fair, accurate and balanced, and I don’t think we did that good a job on the web posting,” Rosenwasser said.
The new disclosure statement notes that Senay, a preventive medicine assistant clinical professor, and Henschke, the head of Mount Sinai’s lung screening program, have never worked together in any capacity.
“The statement is correct,” Senay said. “I do not refer nor have I ever referred patients to Dr. Henschke.”
The statement reads:
“Special correspondent Dr. Emily Senay speaks with Dr. Claudia Henschke of Mount Sinai Hospital. Dr. Henschke is a leading expert in lung cancer screenings.
“Dr. Senay is an Assistant Clinical Professor in the Department of Preventive Medicine at Mount Sinai, and Dr. Henschke is a Professor of Radiology and heads the Lung and Cardiac Screening Program. Other than both being employees of Mount Sinai, they do not work together in any capacity now, nor have they in the past.
“The USPSTF recently gave a high recommendation to low dose CT scans for lung cancer. If the task force finalizes the grade for this screening, healthcare insurers will be required by the Affordable Care Act to cover it fully. Their conversation starts with that premise.”
Rosenwasser said he has questioned Senay about her relationship with Mount Sinai, and takes her word for it.
“In other words, you should take it as a given that we start every day by trying to be honorable in our profession, and so everything follows from trust, everything follows from credibility,” Rosenwasser said. “Our rule here is, if it occurs to us that there is a problem, it’s a problem. So we try to address these things both before we commission a piece, and in the course of reporting a piece.”
Senay: “Who Pays for You?”
PBS did not have to assign a physician-journalist to a story involving one of her colleagues, Schwitzer said.
“If PBS takes one of their other solid journalists, the story wouldn’t even require anyone with medical or health science journalism background,” Schwitzer said.
Rosenwasser said Senay was more important than most correspondents because she’s “actually an expert on a couple different levels.”
“She’s covered many issues related to, obviously, medicine, but also, she did at least one long piece on the Affordable Care Act about hospital readmissions,” Rosenwasser said. “My take is that she understands policy and she’s a doctor, so she’s a viable contributor on that basis—she has medical expertise and policy expertise.”
In a conversation with this reporter, Senay brushed aside the importance of PBS’s web posting, saying her interview with Henschke wasn’t about the value of CT screening.
“My feeling is, you are probably the only person who watched that interview,” Senay said. “We didn’t get into the details and the values of CT screenings, because that is kind of beside the point.
“The little piece that I know that you guys are upset about is [Henschke] giving her numbers—we did not get to include her in the television piece,” Senay said. “You can address it, you can write online that you disagree specifically with her estimations.
“I think this is like an inside-baseball thing, and you have a problem with Henschke’s estimations.”
Senay ended the interview by questioning The Cancer Letter’s motivations for pursuing this story.
“Who pays for you? I mean, where do you get your funding?” Senay asked. “How much pharma money supports your newsletter? And which pharmas advertise in your newsletter?”
The PBS Interview in Question
A transcript of the Senay’s interview with Henschke:
Emily Senay: Is it the idea that the government is paying for it and health insurance will have to pay for it that has people upset about CT lung screening?
Claudia Henschke: No, I think there are some people who just don’t believe in screening. They don’t believe in doing something to people who don’t have symptoms.
ES: Can you quantify how many lives would be saved if the program went forward and Obamacare covered it, and they followed the exact protocol?
CH: I think that some 70 to 80 percent of the people who develop lung cancer, their lives could be saved.
ES: And how many people in the U.S. develop lung cancer every year.
CH: Every year, it’s about 200,000; 200,000 people develop lung cancer, and you could potentially save 70 percent, plus or minus, of those lives.
ES: How did you get into screening for lung cancer in healthy people?
CH: Well, I’m a chest radiologist, so in chest, there are several important diseases. Lung cancer is one of them, pulmonary embolism is another one, and as we started researching and as we saw more CT scans becoming available and seeing little nodules, we thought we should explore the possibility of CT screening.
And there was no database at that time in the early 1990s, so everybody, nobody really knew on what basis they were making follow-up recommendations.
ES: What took so long to screen for what’s the number one killer of both men and women?
CH: The CT screening we started in the early 1990s, but we didn’t complete that study until 1999. And at that point, yes, there was a lot of interest because it was like people described it as a shot heard around the world.
That first study showed we compared chest X-ray and CT on 1,000 people, and we showed that CT finds them early, and over 80 percent were in early stage, and therefore highly curable, and the chest X-ray really didn’t find very many of the cancers.
ES: Was there a bias against developing a screening tool for smokers?
CH: Patients would come, people would come and participate and be very happy about the results, and they would go back to their friends and their friends would say, “Oh, well, I would be dead, I’d rather not know. I’d be dead in one year. Well, that’s true for late-stage cancer. That is true for lung cancer that you don’t find early. Most of them die within a year or year and a half. But if you find it early, that they’re highly curable—you can cure small, early-stage, well over 90 percent of them.
ES: So what is the controversy? Why is there any question about the value of screening high-risk smokers for lung cancer?
CH: Any screening program has benefits and potential harms. When you do CT scans, you find many nodules. Today, the scanners are so good you find almost everybody has a nodule. You don’t want to work up those nodules, so you have to have very careful protocols on how to do it, and that’s how we present it in our first paper. People congratulated us because they said, “You told us how to work up, which ones to work up, and how to do it.”
ES: What about people who say, “Gosh, you’re doing all this exploring, and you’re going to wind up giving people procedures who don’t need the procedure, it’s going to cost a lot of money, it’s going to create anxiety—isn’t that the downside of screening?”
CH: That is the potential downside. So you have to have a very carefully worked-out protocol on who needs further work up, you need to do the imaging at low dose, you need to carefully determine who should have surgery.
But if you follow the steps that we suggest, then really almost all of the people who go to surgery have lung cancer, and you still find it early, you just have to carefully, methodically work out that algorithm.
It makes me feel very happy that people can get the benefit that lives can be saved. I have seen the individuals that we’ve screened and they have productive lives. They say, “I’ve been able to see my grandchildren grow, I’ve seen my son married and all of those things I wouldn’t have seen if I hadn’t gone through your program.” [Henschke begins tearing up.]
So to have that being made available to everybody who is at high-risk is very touching.
