Benefits and harms of CT screening for lung cancer: A systematic review

Peter B. Bach, Joshua N. Mirkin, Thomas K. Oliver, Christopher G. Azzoli, Donald A. Berry, Otis Brawley, Tim Byers, Graham A. Colditz, Michael K. Gould, James R. Jett, Anita L. Sabichi, Rebecca Smith-Bindman, Douglas E. Wood, Amir Qaseem, Frank C. Detterbeck

Research output: Contribution to journalReview article

Abstract

Context: Lung cancer is the leading cause of cancer death. Most patients are diagnosed with advanced disease, resulting in a very low 5-year survival. Screening may reduce the risk of death from lung cancer. Objective: To conduct a systematic review of the evidence regarding the benefits and harms of lung cancer screening using low-dose computed tomography (LDCT). A multisociety collaborative initiative (involving the American Cancer Society, American College of Chest Physicians, American Society of Clinical Oncology, and National Comprehensive Cancer Network) was undertaken to create the foundation for development of an evidence-based clinical guideline. Data Sources: MEDLINE (Ovid: January 1996 to April 2012), EMBASE (Ovid: January 1996 to April 2012), and the Cochrane Library (April 2012). Study Selection: Of 591 citations identified and reviewed, 8 randomized 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 predefined 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 effect of LDCT screening on lung cancer mortality, of which the National Lung Screening Trial was the most informative, demonstrating that among 53 454 participants enrolled, screening resulted in significantly fewer lung cancer deaths (356 vs 443 deaths; lung cancer-specific mortality, 274 vs 309 events per 100000 person-years for LDCT and control groups, respectively; relative risk, 0.80; 95% CI, 0.73-0.93; absolute risk reduction, 0.33%; P=.004). The other 2 smaller studies showed no such benefit. In terms of potential harms of LDCT screening, across all trials and cohorts, approximately 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 percentage of surgical procedures performed in patients with benign lesions. Major complications in those with benign conditions were rare. Conclusion: Low-dose computed tomography screening may benefit individuals at an increased risk for lung cancer, but uncertainty exists about the potential harms of screening and the generalizability of results.

Original languageEnglish (US)
Pages (from-to)2418-2429
Number of pages12
JournalJAMA - Journal of the American Medical Association
Volume307
Issue number22
DOIs
StatePublished - Jun 6 2012
Externally publishedYes

Fingerprint

Lung Neoplasms
Tomography
Mortality
Numbers Needed To Treat
Information Storage and Retrieval
Smoking Cessation
Early Detection of Cancer
MEDLINE
Libraries
Uncertainty
Cause of Death
Neoplasms
Consensus
Cohort Studies
Guidelines
Biopsy
Lung
Control Groups
Survival

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bach, P. B., Mirkin, J. N., Oliver, T. K., Azzoli, C. G., Berry, D. A., Brawley, O., ... Detterbeck, F. C. (2012). Benefits and harms of CT screening for lung cancer: A systematic review. JAMA - Journal of the American Medical Association, 307(22), 2418-2429. https://doi.org/10.1001/jama.2012.5521

Benefits and harms of CT screening for lung cancer : A systematic review. / Bach, Peter B.; Mirkin, Joshua N.; Oliver, Thomas K.; Azzoli, Christopher G.; Berry, Donald A.; Brawley, Otis; Byers, Tim; Colditz, Graham A.; Gould, Michael K.; Jett, James R.; Sabichi, Anita L.; Smith-Bindman, Rebecca; Wood, Douglas E.; Qaseem, Amir; Detterbeck, Frank C.

In: JAMA - Journal of the American Medical Association, Vol. 307, No. 22, 06.06.2012, p. 2418-2429.

Research output: Contribution to journalReview article

Bach, PB, Mirkin, JN, Oliver, TK, Azzoli, CG, Berry, DA, Brawley, O, Byers, T, Colditz, GA, Gould, MK, Jett, JR, Sabichi, AL, Smith-Bindman, R, Wood, DE, Qaseem, A & Detterbeck, FC 2012, 'Benefits and harms of CT screening for lung cancer: A systematic review', JAMA - Journal of the American Medical Association, vol. 307, no. 22, pp. 2418-2429. https://doi.org/10.1001/jama.2012.5521
Bach, Peter B. ; Mirkin, Joshua N. ; Oliver, Thomas K. ; Azzoli, Christopher G. ; Berry, Donald A. ; Brawley, Otis ; Byers, Tim ; Colditz, Graham A. ; Gould, Michael K. ; Jett, James R. ; Sabichi, Anita L. ; Smith-Bindman, Rebecca ; Wood, Douglas E. ; Qaseem, Amir ; Detterbeck, Frank C. / Benefits and harms of CT screening for lung cancer : A systematic review. In: JAMA - Journal of the American Medical Association. 2012 ; Vol. 307, No. 22. pp. 2418-2429.
@article{2d30b4d79e1443288f737558a7ca1486,
title = "Benefits and harms of CT screening for lung cancer: A systematic review",
abstract = "Context: Lung cancer is the leading cause of cancer death. Most patients are diagnosed with advanced disease, resulting in a very low 5-year survival. Screening may reduce the risk of death from lung cancer. Objective: To conduct a systematic review of the evidence regarding the benefits and harms of lung cancer screening using low-dose computed tomography (LDCT). A multisociety collaborative initiative (involving the American Cancer Society, American College of Chest Physicians, American Society of Clinical Oncology, and National Comprehensive Cancer Network) was undertaken to create the foundation for development of an evidence-based clinical guideline. Data Sources: MEDLINE (Ovid: January 1996 to April 2012), EMBASE (Ovid: January 1996 to April 2012), and the Cochrane Library (April 2012). Study Selection: Of 591 citations identified and reviewed, 8 randomized 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 predefined 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 effect of LDCT screening on lung cancer mortality, of which the National Lung Screening Trial was the most informative, demonstrating that among 53 454 participants enrolled, screening resulted in significantly fewer lung cancer deaths (356 vs 443 deaths; lung cancer-specific mortality, 274 vs 309 events per 100000 person-years for LDCT and control groups, respectively; relative risk, 0.80; 95{\%} CI, 0.73-0.93; absolute risk reduction, 0.33{\%}; P=.004). The other 2 smaller studies showed no such benefit. In terms of potential harms of LDCT screening, across all trials and cohorts, approximately 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 percentage of surgical procedures performed in patients with benign lesions. Major complications in those with benign conditions were rare. Conclusion: Low-dose computed tomography screening may benefit individuals at an increased risk for lung cancer, but uncertainty exists about the potential harms of screening and the generalizability of results.",
author = "Bach, {Peter B.} and Mirkin, {Joshua N.} and Oliver, {Thomas K.} and Azzoli, {Christopher G.} and Berry, {Donald A.} and Otis Brawley and Tim Byers and Colditz, {Graham A.} and Gould, {Michael K.} and Jett, {James R.} and Sabichi, {Anita L.} and Rebecca Smith-Bindman and Wood, {Douglas E.} and Amir Qaseem and Detterbeck, {Frank C.}",
year = "2012",
month = "6",
day = "6",
doi = "10.1001/jama.2012.5521",
language = "English (US)",
volume = "307",
pages = "2418--2429",
journal = "JAMA - Journal of the American Medical Association",
issn = "0098-7484",
publisher = "American Medical Association",
number = "22",

}

TY - JOUR

T1 - Benefits and harms of CT screening for lung cancer

T2 - A systematic review

AU - Bach, Peter B.

AU - Mirkin, Joshua N.

AU - Oliver, Thomas K.

AU - Azzoli, Christopher G.

AU - Berry, Donald A.

AU - Brawley, Otis

AU - Byers, Tim

AU - Colditz, Graham A.

AU - Gould, Michael K.

AU - Jett, James R.

AU - Sabichi, Anita L.

AU - Smith-Bindman, Rebecca

AU - Wood, Douglas E.

AU - Qaseem, Amir

AU - Detterbeck, Frank C.

PY - 2012/6/6

Y1 - 2012/6/6

N2 - Context: Lung cancer is the leading cause of cancer death. Most patients are diagnosed with advanced disease, resulting in a very low 5-year survival. Screening may reduce the risk of death from lung cancer. Objective: To conduct a systematic review of the evidence regarding the benefits and harms of lung cancer screening using low-dose computed tomography (LDCT). A multisociety collaborative initiative (involving the American Cancer Society, American College of Chest Physicians, American Society of Clinical Oncology, and National Comprehensive Cancer Network) was undertaken to create the foundation for development of an evidence-based clinical guideline. Data Sources: MEDLINE (Ovid: January 1996 to April 2012), EMBASE (Ovid: January 1996 to April 2012), and the Cochrane Library (April 2012). Study Selection: Of 591 citations identified and reviewed, 8 randomized 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 predefined 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 effect of LDCT screening on lung cancer mortality, of which the National Lung Screening Trial was the most informative, demonstrating that among 53 454 participants enrolled, screening resulted in significantly fewer lung cancer deaths (356 vs 443 deaths; lung cancer-specific mortality, 274 vs 309 events per 100000 person-years for LDCT and control groups, respectively; relative risk, 0.80; 95% CI, 0.73-0.93; absolute risk reduction, 0.33%; P=.004). The other 2 smaller studies showed no such benefit. In terms of potential harms of LDCT screening, across all trials and cohorts, approximately 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 percentage of surgical procedures performed in patients with benign lesions. Major complications in those with benign conditions were rare. Conclusion: Low-dose computed tomography screening may benefit individuals at an increased risk for lung cancer, but uncertainty exists about the potential harms of screening and the generalizability of results.

AB - Context: Lung cancer is the leading cause of cancer death. Most patients are diagnosed with advanced disease, resulting in a very low 5-year survival. Screening may reduce the risk of death from lung cancer. Objective: To conduct a systematic review of the evidence regarding the benefits and harms of lung cancer screening using low-dose computed tomography (LDCT). A multisociety collaborative initiative (involving the American Cancer Society, American College of Chest Physicians, American Society of Clinical Oncology, and National Comprehensive Cancer Network) was undertaken to create the foundation for development of an evidence-based clinical guideline. Data Sources: MEDLINE (Ovid: January 1996 to April 2012), EMBASE (Ovid: January 1996 to April 2012), and the Cochrane Library (April 2012). Study Selection: Of 591 citations identified and reviewed, 8 randomized 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 predefined 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 effect of LDCT screening on lung cancer mortality, of which the National Lung Screening Trial was the most informative, demonstrating that among 53 454 participants enrolled, screening resulted in significantly fewer lung cancer deaths (356 vs 443 deaths; lung cancer-specific mortality, 274 vs 309 events per 100000 person-years for LDCT and control groups, respectively; relative risk, 0.80; 95% CI, 0.73-0.93; absolute risk reduction, 0.33%; P=.004). The other 2 smaller studies showed no such benefit. In terms of potential harms of LDCT screening, across all trials and cohorts, approximately 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 percentage of surgical procedures performed in patients with benign lesions. Major complications in those with benign conditions were rare. Conclusion: Low-dose computed tomography screening may benefit individuals at an increased risk for lung cancer, but uncertainty exists about the potential harms of screening and the generalizability of results.

UR - http://www.scopus.com/inward/record.url?scp=84862255365&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862255365&partnerID=8YFLogxK

U2 - 10.1001/jama.2012.5521

DO - 10.1001/jama.2012.5521

M3 - Review article

C2 - 22610500

AN - SCOPUS:84862255365

VL - 307

SP - 2418

EP - 2429

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0098-7484

IS - 22

ER -