Lung Cancer Screening with Low-Dose CT in Smokers: A Systematic Review and Meta-Analysis.

Theresa Hunger,Eva Wanka-Pail,Gunnar Brix,Jürgen Griebel

doi:10.3390/diagnostics11061040

Theresa Hunger, Eva Wanka-Pail + Show 2 more

Open Access

https://doi.org/10.3390/diagnostics11061040

Copy DOI

Abstract

Lung cancer continues to be one of the main causes of cancer death in Europe. Low-dose computed tomography (LDCT) has shown high potential for screening of lung cancer in smokers, most recently in two European trials. The aim of this review was to assess lung cancer screening of smokers by LDCT with respect to clinical effectiveness, radiological procedures, quality of life, and changes in smoking behavior. We searched electronic databases in April 2020 for publications of randomized controlled trials (RCT) reporting on lung cancer and overall mortality, lung cancer morbidity, and harms of LDCT screening. A meta-analysis was performed to estimate effects on mortality. Forty-three publications on 10 RCTs were included. The meta-analysis of eight studies showed a statistically significant relative reduction of lung cancer mortality of 12% in the screening group (risk ratio = 0.88; 95% CI: 0.79–0.97). Between 4% and 24% of screening-LDCT scans were classified as positive, and 84–96% of them turned out to be false positive. The risk of overdiagnosis was estimated between 19% and 69% of diagnosed lung cancers. Lung cancer screening can reduce disease-specific mortality in (former) smokers when stringent requirements and quality standards for performance are met.

Highlights

Detection of diseases before they cause symptoms or discomfort is becoming increasingly important in the health care systems of many countries
It may be criticized that the NLST used chest X-ray as comparator instead of no intervention; earlier studies suggested that X-ray lung screening has no significant effect and, that it could be treated as no screening [74]
The meta-analysis of randomized controlled trials (RCT) on Low-dose computed tomography (LDCT) lung cancer screening presented in this review takes into account the most recent results of two European screening studies published in 2020

Summary

Introduction

Detection of diseases before they cause symptoms or discomfort is becoming increasingly important in the health care systems of many countries. The rapid technological development of radiological imaging procedures in the recent years has led to an increasingly frequent use of these procedures in symptomatic persons, i.e., patients, and to early diagnosis of asymptomatic persons [1] This is true for computed tomography (CT), which is predestined for screening of serious diseases due to its high spatial and temporal resolution. The International Basic Safety Standards for Protection against Ionizing Radiation [3] and the European Directive 2013/59/Euratom [4] have published basic conditions for the use of radiological imaging procedures in early detection Both regulations place high demands on the justification process, i.e., the risk-benefit assessment, on the basis of scientific evidence. We assessed benefits and harms of lung cancer screening with low-dose computed tomography (LDCT) in smokers and former smokers

Objectives

Methods

Results

Discussion

Conclusion