CHEST Guidelines-Rebuttal From Dr. McCunney

Rebuttal From Dr. McCunney

Pdf Summary

The document discusses various perspectives on the potential risks and benefits of low-dose radiation exposure, particularly in relation to lung cancer screening programs using CT scans. Dr. McCunney and Dr. Doss debate the implications of radiation exposure from such screenings.<br /><br />Dr. McCunney acknowledges that there is no uniform definition of low-dose radiation and notes that the radiation concerns in therapeutic and diagnostic uses are often insignificant. However, he highlights that lung cancer screening programs involve repeated exposure, potentially leading to significant cumulative radiation doses. The National Lung Screening Trial (NLST) showed that most nodules detected in screenings are benign, which raises concerns about unnecessary radiation exposure in follow-up processes. Dr. McCunney stresses the difficulty in setting a precise threshold for radiation-induced cancer due to varying exposure scenarios and insists on refining follow-up criteria to minimize exposure without compromising healthcare.<br /><br />Dr. Doss argues against concerns of carcinogenic risks from low-dose radiation exposure, suggesting that the hypothesis of linear no-threshold (LNT) is not supported by current data, especially from atomic bomb survivor studies. He claims that low-dose radiation may stimulate adaptive protection mechanisms in the body, reducing overall cancer risk through decreased endogenous DNA damage. Dr. Doss emphasizes that concerns about LDR from CT scans are unjustified and asserts that adaptive protection from LDR could even reduce cancer risk in smokers undergoing repeated scans.<br /><br />Additionally, the document includes updates and corrections to conflicts of interest, indicating that Dr. McCunney, although not compensated by relevant organizations, served as a consultant in litigation involving lung cancer and its risks. This context raises questions about potential biases in analyses related to radiation exposure and its implications for patient care.

Keywords

low-dose radiation

lung cancer screening

CT scans

radiation exposure

Dr. McCunney

Dr. Doss

National Lung Screening Trial

linear no-threshold hypothesis

adaptive protection

conflicts of interest