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Screening for Lung Cancer With Low-Dose Computed Tomography: Updated Evidence Report and Systematic Review for the US

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Low-dose computed tomography (LDCT) screening can reduce lung cancer deaths in high-risk individuals. However, it carries risks like false positives, overdiagnosis, and radiation exposure, necessitating careful consideration of benefits versus harms.

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Area of Science:

  • Pulmonology
  • Radiology
  • Preventive Medicine

Background:

  • Lung cancer is the leading cause of cancer-related death in the US.
  • Evidence review for US Preventive Services Task Force (USPSTF) recommendations on lung cancer screening.

Purpose of the Study:

  • To review evidence on low-dose computed tomography (LDCT) screening for lung cancer.
  • To inform USPSTF guidelines regarding lung cancer screening.

Main Methods:

  • Systematic review of English-language studies from MEDLINE, Cochrane Library, and trial registries up to May 2019, with literature surveillance through November 2020.
  • Included studies on LDCT screening, accuracy, risk prediction models, and early-stage lung cancer treatment.
  • Dual review of abstracts, full-text articles, and study quality with qualitative synthesis; data were not pooled due to heterogeneity.

Main Results:

  • Seven randomized clinical trials (RCTs) involving 86,486 participants evaluated LDCT screening.
  • The National Lung Screening Trial (NLST) showed a reduction in lung cancer mortality (IRR 0.85) with LDCT screening for high-risk individuals aged 55-74.
  • The Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) trial demonstrated a reduction in lung cancer mortality (IRR 0.75) for high-risk individuals aged 50-74.

Conclusions:

  • LDCT screening can decrease lung cancer mortality in high-risk populations.
  • Screening poses risks including false-positive results, unnecessary procedures, overdiagnosis, and radiation exposure.
  • Current nodule evaluation protocols may mitigate some harms, but further research is needed.