Abstract

Lung cancer screening programmes using chest X-ray and sputum cytology are routinely performed in Japan; however, the efficacy is insufficient. Screening using low-dose computed tomography (CT) is a more effective approach and has the potential to detect the disease more accurately. A total of 7183 low-dose CT screening tests for 4689 participants and 36 085 chest X-ray screening tests for 13 381 participants were conducted between August 1998 and May 2002. Sensitivity and specificity of lung cancer screening were calculated by both the detection method and the incidence method by linkage of the screening database and the Cancer Registry database. The preclinical detectable phase was assumed to be 1 year. Sensitivity and specificity by the detection method were 88.9 and 92.6% for low-dose CT and 78.3 and 97.0% for chest X-ray, respectively. Sensitivity of low-dose CT by the incidence method was 79.5%, whereas that of chest X-ray was 86.5%. Lung cancer screening using low-dose CT resulted in higher sensitivity and lower specificity than traditional screening according to the detection method. However, sensitivity by the incidence method was not as high as this. These findings demonstrate the potential for overdiagnosis in CT screening-detected cases.

Highlights

  • Annual lung cancer screening using low-dose computed tomography (CT) has been performed as an opportunistic screening method since the early 1990s in Japan

  • The present study is the first report on sensitivity and specificity of annual lung cancer screening using low-dose CT and data from a local Cancer Registry

  • Sensitivity and specificity of low-dose CT screening according to the detection method were 88.9 and 92.6%

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Summary

Introduction

Annual lung cancer screening using low-dose computed tomography (CT) has been performed as an opportunistic screening method since the early 1990s in Japan. Several study groups introduced low-dose CT for population-based screening in clinical trials. These previous studies reported a high detection rate, an ability to detect small tumours and a high survival rate in detected cases (Henschke et al, 2001, 2006; Sone et al, 2001; Nawa et al, 2002; Sobue et al, 2002a; Swensen et al, 2002; Diederich et al, 2004; Jett, 2005; Libby et al, 2006). Some studies referred to interval cancer cases of lung cancer screening using low-dose CT, and one study referred to the sensitivity of screening (Sone et al, 2001; Diederich et al, 2004).

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