Computed tomography screening and lung cancer outcomes

Area of Science:

• Pulmonology
• Oncology
• Radiology

Background:

• Lung cancer screening with computed tomography (CT) is being implemented for smokers, but evidence on its impact on outcomes is limited.
• Randomized controlled trials are ongoing to further evaluate CT screening efficacy.

Purpose of the Study:

• To determine if lung cancer screening increases diagnosis and resection frequency.
• To assess if screening reduces the risk of advanced lung cancer diagnosis or lung cancer mortality.

Main Methods:

• A longitudinal analysis of 3246 asymptomatic smokers undergoing annual CT screening from 1998.
• Follow-up for a median of 3.9 years at US and Italian academic medical centers.
• Comparison of observed lung cancer diagnoses, resections, advanced cases, and deaths against expected values.

Main Results:

• Lung cancer diagnosis occurred in 144 individuals versus 44.5 expected (RR, 3.2).
• Lung cancer resections were performed in 109 individuals versus 10.9 expected (RR, 10.0).
• No significant reduction in advanced lung cancer diagnoses (42 vs 33.4 expected) or lung cancer deaths (38 vs 38.8 expected) was observed.

Conclusions:

• Low-dose CT screening for lung cancer may increase diagnosis and treatment rates.
• Screening did not substantially decrease the risk of advanced lung cancer or lung cancer-related death.
• Asymptomatic individuals should only be screened within clinical research studies until definitive data are available.