Hesitancy around low-dose CT screening for lung cancer

Area of Science:

• Oncology
• Radiology
• Public Health

Background:

• Lung cancer is a leading global cause of cancer death, with poor survival rates often due to late-stage diagnosis.
• Early detection through screening is crucial for improving lung cancer survival outcomes.
• While low-dose computed tomography (LDCT) has shown significant mortality reductions, population-based European screening programs have lagged.

Purpose of the Study:

• To review the evidence for low-dose computed tomography (LDCT) lung cancer screening (LCS).
• To identify and address barriers and concerns hindering the implementation of national LCS programs.
• To advocate for the adoption of unified LCS programs across Europe.

Main Methods:

• Review of evidence from major lung cancer screening trials (e.g., National Lung Screening Trial, NELSON study).
• Analysis of potential barriers including false positives, overdiagnosis, psychological impact, risk stratification, radiation exposure, and incidental findings.
• Evaluation of existing mitigation strategies for identified concerns.

Main Results:

• LDCT screening has demonstrated significant reductions in lung cancer-specific mortality (20-24%) compared to radiography or no screening.
• Key concerns such as false positives, overdiagnosis, and radiation exposure have identifiable mitigation strategies.
• Despite challenges, the benefits of LDCT LCS outweigh the risks when managed appropriately.

Conclusions:

• LDCT lung cancer screening is an effective tool for reducing mortality.
• Existing evidence supports the refinement and implementation of national, unified lung cancer screening programs.
• Mitigation strategies exist for identified risks, and these should not impede the rollout of LCS programs.