Giulia Veronesi, MD; Patrick Maisonneuve, DipEng; Massimo Bellomi, MD, PhD; Cristiano Rampinelli, MD; Iara Durli, MD; Raffaella Bertolotti, MSc; Lorenzo Spaggiari, MD, PhD
Acknowledgment: The authors thank Giovanna Ciambrone for secretarial assistance and Daniela Rampazzo for secretarial assistance and COSMOS study data entry. They also thank the medical staff of the European Institute of Oncology Divisions of Thoracic Surgery and of Radiology, as well as Giuseppe Bardo and other European Institute of Oncology radiology technicians, all of whom contributed to the COSMOS study. Finally, they thank Don Ward for help with the English translation.
Grant Support: By the Italian Association for Cancer Research.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1606.
Reproducible Research Statement: Study protocol: Available at http://clinicaltrials.gov/ct2/show/NCT01248806. Statistical code and data set: Certain portions are available from Dr. Veronesi (e-mail, firstname.lastname@example.org).
Requests for Single Reprints: Giulia Veronesi, MD, Division of Thoracic Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy; e-mail, email@example.com.
Current Author Addresses: Dr. Veronesi, Ms. Bertoletti, and Dr. Spaggiari: Division of Thoracic Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
Mr. Maisonneuve: Division of Epidemiology; European Institute of Oncology, Via Ramusio 1, 20141 Milan, Italy.
Drs. Bellomi, Rampinelli, and Durli: Division of Radiology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
Author Contributions: Conception and design: G. Veronesi, M. Bellomi, C. Rampinelli.
Analysis and interpretation of the data: G. Veronesi, P. Maisonneuve, M. Bellomi, C. Rampinelli, I. Durli.
Drafting of the article: G. Veronesi, C. Rampinelli.
Critical revision of the article for important intellectual content: G. Veronesi, P. Maisonneuve, M. Bellomi, C. Rampinelli.
Final approval of the article: G. Veronesi, P. Maisonneuve, M. Bellomi, C. Rampinelli, L. Spaggiari.
Provision of study materials or patients: G. Veronesi, L. Spaggiari.
Statistical expertise: P. Maisonneuve.
Obtaining of funding: L. Spaggiari.
Administrative, technical, or logistic support: L. Spaggiari.
Collection and assembly of data: G. Veronesi, I. Durli, R. Bertoletti.
Veronesi G, Maisonneuve P, Bellomi M, Rampinelli C, Durli I, Bertolotti R, et al. Estimating Overdiagnosis in Low-Dose Computed Tomography Screening for Lung Cancer: A Cohort Study. Ann Intern Med. 2012;157:776-784. doi: 10.7326/0003-4819-157-11-201212040-00005
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Published: Ann Intern Med. 2012;157(11):776-784.
Lung cancer screening may detect cancer that will never become symptomatic (overdiagnosis), leading to overtreatment. Changes in size on sequential low-dose computed tomography (LDCT) screening, expressed as volume-doubling time (VDT), may help to distinguish aggressive cancer from cases that are unlikely to become symptomatic.
To assess VDT for screening-detected lung cancer as an indicator of overdiagnosis.
Retrospective estimation of the VDT of cancer detected in a prospective LDCT screening cohort.
Nonrandomized, single-center screening study involving persons at high risk for lung cancer enrolled between 2004 and 2005 who received LDCT annually for 5 years.
175 study patients diagnosed with primary lung cancer.
VDT was measured on LDCT and classified as fast-growing (<400 days), slow-growing (between 400 and 599 days), or indolent (≥600 days).
Fifty-five cases of cancer were diagnosed at baseline, and 120 were diagnosed subsequently. Of the latter group, 19 cases (15.8%) were new (not visible on previous scans) and fast-growing (median VDT, 52 days); 101 (84.2%) were progressive, including 70 (58.3%) fast-growing and 31 (25.8%) slow-growing (15.0%) or indolent (10.8%) cases. Lung cancer–specific mortality was significantly higher (9.2% per year) in patients with new compared with slow-growing or indolent (0.9% per year) cancer. Sixty percent of fast-growing progressive cancer and 45% of new cancer were stage I, for which survival was good.
This is a retrospective study. Volume-doubling time can only indicate overdiagnosis and was estimated for new cancer from 1 measurement (a diameter of 2 mm assumed the previous year).
Slow-growing or indolent cancer comprised approximately 25% of incident cases, many of which may have been overdiagnosed. To limit overtreatment in these cases, minimally invasive limited resection and nonsurgical treatments should be investigated.
Italian Association for Cancer Research.
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Hematology/Oncology, Pulmonary/Critical Care, Lung Cancer, Cancer Screening/Prevention, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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