Benefits and Harms of CT Screening for Lung Cancer: A Systematic Review
By P. Bach, J. Mirkin, T. Oliver, C. Azzoli, D. Berry, O. Brawley, T. Byers, Graham A Colditz, M. Gould, J. Jett and 5 more. Journal of the American Medical Association (JAMA), 2012
1,194 citations recorded by the source corpus.
Context Lung cancer is the leading cause of cancer death. Most patients are diagnosed with advanced disease, resulting in a very low five-year survival rate. Screening may reduce the risk of death from lung cancer. Objective A multi-society collaborative initiative (involving the American Cancer Society, the American College of Chest Physicians, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network) was undertaken to conduct a systematic review of the evidence regarding the benefits and harms of lung cancer screening using low dose computed tomography (LDCT), in order to create the foundation for development of an evidence-based clinical guideline. Data Sources MEDLINE (OVID: 1996 to April 2012), EMBASE (OVID: 1996 to April 2012), and the Cochrane Library (April 2012). Study Selection Of 591 citations identified and reviewed, eight randomized controlled trials and 13 cohort studies of LDCT screening met criteria for inclusion. Primary outcomes were lung cancer mortality and all-cause mortality, and secondary outcomes included nodule detection, invasive procedures, follow-up tests, and smoking cessation. Data Extraction Critical appraisal using pre-defined criteria was conducted on individual studies and the overall body of evidence. Differences in data extracted by reviewers were adjudicated by consensus. Results Three randomized studies provided evidence on the impact of LDCT screening on lung cancer mortality, of which the National Lung Screening Trial was the most informative, demonstrating that among 53,454 enrolled, screening resulted in significantly fewer lung cancer deaths (356 vs 443 deaths; lung cancer-specific mortality, 247 vs 309 events per 100,000 person-years for LDCT and control groups, respectively; Relative Risk [RR] = 0.80, 95% Confidence Interval [CI] 0.73–0.93; Absolute Risk Reduction [ARR] = 0.33%, P=0.004). The other 2 smaller studies showed no such benefit. In terms of potential harms of LDCT screening, across all trials and cohorts, about 20% of individuals in each round of screening had positive results requiring some degree of follow-up, while approximately 1% had lung cancer. There was marked heterogeneity in this finding and in the frequency of follow-up investigations, biopsies, and the percent of surgical procedures performed in those with benign lesions. Major complications in those with benign conditions were rare. Conclusions LDCT screening may benefit individuals at an elevated risk for lung cancer, but uncertainty exists about potential harms and the generalizability of results.
Subfields: Oncology, Pulmonary and Respiratory Medicine
View Paper: https://www.semanticscholar.org/paper/4ce95b4a3d92699a03f2bef020a996a2318b4671
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Citations in the corpus
- Lung Nodule Classification Using Deep Features in CT Images (2015, background): “Keywords-Computer-aided diagnosis (CAD), LIDC, deep features, autoencoder, lung nodule I. INTRODUCTION Lung cancer is the leading cause of cancer deaths in North America and worldwide among both men and women [1], [2].”
- Screening for Lung Cancer: U.S. Preventive Services Task Force Recommendation Statement (2014, positive): “In 2012, the American College of Chest Physicians, the American Society of Clinical Oncology, and the American Thoracic Society (19) recommended screening for lung cancer with LDCT primarily on the basis of results from the NLST, using eligibility criteria that closely modeled those of the NLST (per”