Alfred I. Neugut, MD, PhD; Melissa K. Accordino, MD
What are the benefits and risks of lung cancer screening with low-dose computed tomography (LDCT) in patients at increased risk for lung cancer due to smoking and age?
Included studies evaluated LDCT screening for lung cancer and reported ≥ 1 of the following outcomes: lung cancer−specific or all-cause mortality, nodule detection rate, frequency of additional imaging, frequency of invasive diagnostic procedures (e.g., needle or bronchoscopic biopsy, surgical biopsy, or surgical resection), complications from evaluation of suspected lung cancer, or rate of smoking cessation or reinitiation. Exclusion criteria were studies with risk factors other than smoking, and meta-analyses or case reports of patients diagnosed with lung cancer.
MEDLINE, EMBASE/Excerpta Medica, and Cochrane Library (all to Apr 2012); and reference lists of related articles and reviews were searched for published, English-language, randomized, controlled trials (RCTs) or cohort studies. 8 RCTs (n = 83 331, lower age range 47 to 60 y, upper age range 69 to 80 y; 55% to 100% men; ≥ 15 to ≥ 30 pack-y of smoking; < 10 to ≤ 15 y since smoking cessation) and 13 cohort studies met inclusion criteria. Only the results of RCTs are reported in this abstract. 5 RCTs compared LDCT with no screening and 3 with chest radiography. 4 RCTs reported preliminary data only. 3 RCTs reported mortality. Data were not pooled.
CT screening reduced risk for all-cause and lung cancer mortality more than chest radiography in the largest trial; CT screening and usual care did not differ in 2 trials (Table). Average nodule detection rate across 8 RCTs was 20% (range 3% to 30%); in 6 RCTs, including all 3 comparing LDCT with chest radiography, > 90% of nodules were benign.
In patients at increased risk for lung cancer, low-dose computed tomography screening for lung cancer detection reduced lung cancer–specific and all-cause mortality more than chest radiography in 1 large trial but showed no effect compared with usual care in 2 smaller trials.
Low-dose computed tomography (LDCT) screening vs chest radiography or usual care for lung cancer detection*
*DANTE = Detection and Screening of Early Lung Cancer by Novel Imaging Technology and Molecular Essays; DLCST = Danish Lung Cancer Screening Trial; NLST = National Lung Screening Trial; NS = not significant; NNS = number needed to screen; other abbreviations defined in Glossary.
†Compared with chest radiography.
‡Compared with usual care.
Neugut AI, Accordino MK. Review: CT screening for lung cancer reduced mortality in 1 large trial but not in 2 smaller trials. Ann Intern Med. ;157:JC3–6. doi: 10.7326/0003-4819-157-6-201209180-02006
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Published: Ann Intern Med. 2012;157(6):JC3-6.
Cancer Screening/Prevention, Hematology/Oncology, Lung Cancer, Prevention/Screening, Pulmonary/Critical Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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