Abstract
BackgroundMortality outcomes in trials of low-dose computed tomography (CT) screening for lung cancer are inconsistent. This study aimed to evaluate whether CT screening in urban areas of China could reduce lung cancer mortality and to investigate the factors that associate with the screening effect.MethodsA decision tree model with three scenarios (low-dose CT screening, chest X-ray screening, and no screening) was developed to compare screening results in a simulated Chinese urban cohort (100,000 smokers aged 45–80 years). Data of participant characteristics were obtained from national registries and epidemiological surveys for estimating lung cancer prevalence. The selection of other tree variables such as sensitivities and specificities of low-dose CT and chest X-ray screening were based on literature research. Differences in lung cancer mortality (primary outcome), false diagnoses, and deaths due to false diagnosis were calculated. Sensitivity analyses were performed to identify the factors that associate with the screening results and to ascertain worst and optimal screening effects considering possible ranges of the variables.ResultsAmong the 100,000 subjects, there were 448, 541, and 591 lung cancer deaths in the low-dose CT, chest X-ray, and no screening scenarios, respectively (17.2% reduction in low-dose CT screening over chest X-ray screening and 24.2% over no screening). The costs of the two screening scenarios were 9387 and 2497 false diagnoses and 7 and 2 deaths due to false diagnosis among the 100,000 persons, respectively. The factors that most influenced death reduction with low-dose CT screening over no screening were lung cancer prevalence in the screened cohort, low-dose CT sensitivity, and proportion of early-stage cancers among low-dose CT detected lung cancers. Considering all possibilities, reduction in deaths (relative numbers) with low-dose CT screening in the worst and optimal cases were 16 (5.4%) and 288 (40.2%) over no screening, respectively.ConclusionsIn terms of mortality outcomes, our findings favor conducting low-dose CT screening in urban China. However, approaches to reducing false diagnoses and optimizing important screening conditions such as enrollment criteria for screening are highly needed.
Highlights
Mortality outcomes in trials of low-dose computed tomography (CT) screening for lung cancer are inconsistent
As to the outcomes in the three scenarios for the same cohort, the number of lung cancer deaths in the low-dose CT screening scenario was 448, a reduction of 143 (24.2%) over the no screening scenario (591 lung cancer deaths); low-dose CT screening resulted in 9387 false diagnoses and 7 deaths due to false diagnosis
In the chest X-ray screening scenario, there were 541 lung cancer deaths, a reduction of 50 (8.5%) over the no screening scenario, and chest X-ray screening resulted in 2497 false diagnoses and 2 deaths due to false diagnosis
Summary
Mortality outcomes in trials of low-dose computed tomography (CT) screening for lung cancer are inconsistent. This study aimed to evaluate whether CT screening in urban areas of China could reduce lung cancer mortality and to investigate the factors that associate with the screening effect. In China, a country with 36% of all lung cancers worldwide [15], mortality outcome, which is the most important measure for assessing screening effects, has not yet been evaluated despite numerous preliminary studies on diagnostic accuracy [16]. There is a need to investigate whether early detection by low-dose CT screening could reduce lung cancer mortality in China and to investigate the variations in screening effects before introducing such screening countrywide. This study aimed to analyze differences in lung cancer mortality between three scenarios using available data from China and to identify factors that most strongly influence the outcomes in low-dose CT screening
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