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- Title
Screening for Lung Cancer With Low-Dose Computed Tomography: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.
- Authors
Jonas, Daniel E.; Reuland, Daniel S.; Reddy, Shivani M.; Nagle, Max; Clark, Stephen D.; Weber, Rachel Palmieri; Enyioha, Chineme; Malo, Teri L.; Brenner, Alison T.; Armstrong, Charli; Coker-Schwimmer, Manny; Middleton, Jennifer Cook; Voisin, Christiane; Harris, Russell P.
- Abstract
<bold>Importance: </bold>Lung cancer is the leading cause of cancer-related death in the US.<bold>Objective: </bold>To review the evidence on screening for lung cancer with low-dose computed tomography (LDCT) to inform the US Preventive Services Task Force (USPSTF).<bold>Data Sources: </bold>MEDLINE, Cochrane Library, and trial registries through May 2019; references; experts; and literature surveillance through November 20, 2020.<bold>Study Selection: </bold>English-language studies of screening with LDCT, accuracy of LDCT, risk prediction models, or treatment for early-stage lung cancer.<bold>Data Extraction and Synthesis: </bold>Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings. Data were not pooled because of heterogeneity of populations and screening protocols.<bold>Main Outcomes and Measures: </bold>Lung cancer incidence, lung cancer mortality, all-cause mortality, test accuracy, and harms.<bold>Results: </bold>This review included 223 publications. Seven randomized clinical trials (RCTs) (N = 86 486) evaluated lung cancer screening with LDCT; the National Lung Screening Trial (NLST, N = 53 454) and Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON, N = 15 792) were the largest RCTs. Participants were more likely to benefit than the US screening-eligible population (eg, based on life expectancy). The NLST found a reduction in lung cancer mortality (incidence rate ratio [IRR], 0.85 [95% CI, 0.75-0.96]; number needed to screen [NNS] to prevent 1 lung cancer death, 323 over 6.5 years of follow-up) with 3 rounds of annual LDCT screening compared with chest radiograph for high-risk current and former smokers aged 55 to 74 years. NELSON found a reduction in lung cancer mortality (IRR, 0.75 [95% CI, 0.61-0.90]; NNS to prevent 1 lung cancer death of 130 over 10 years of follow-up) with 4 rounds of LDCT screening with increasing intervals compared with no screening for high-risk current and former smokers aged 50 to 74 years. Harms of screening included radiation-induced cancer, false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, incidental findings, and increases in distress. For every 1000 persons screened in the NLST, false-positive results led to 17 invasive procedures (number needed to harm, 59) and fewer than 1 person having a major complication. Overdiagnosis estimates varied greatly (0%-67% chance that a lung cancer was overdiagnosed). Incidental findings were common, and estimates varied widely (4.4%-40.7% of persons screened).<bold>Conclusions and Relevance: </bold>Screening high-risk persons with LDCT can reduce lung cancer mortality but also causes false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, incidental findings, increases in distress, and, rarely, radiation-induced cancers. Most studies reviewed did not use current nodule evaluation protocols, which might reduce false-positive results and invasive procedures for false-positive results.
- Subjects
LUNG cancer; EARLY detection of cancer; MEDICAL screening; COMPUTED tomography; U.S. Preventive Services Task Force; CAUSES of death; LUNGS; SYSTEMATIC reviews; LUNG tumors; UNNECESSARY surgery; MEDICAL protocols; SMOKING; DIAGNOSTIC errors
- Publication
JAMA: Journal of the American Medical Association, 2021, Vol 325, Issue 10, p971
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.2021.0377