Screening for Lung Cancer, Overdiagnosis, and Healthcare Utilization: A Nationwide Population-Based Study.

Area of Science:

• Oncology
• Public Health
• Radiology

Background:

• Guideline-discordant low-dose computed tomography (LDCT) screening for lung cancer (LC) may lead to overdiagnosis, but the extent and consequences remain unclear.
• This study investigates the prevalence of self-initiated, non-reimbursed LDCT screening in a predominantly non-smoking population and its impact on LC epidemiology and healthcare utilization.

Purpose of the Study:

• To examine the prevalence of guideline-discordant LDCT screening.
• To assess the impact of this screening on lung cancer incidence, mortality, stage at diagnosis, survival rates, and healthcare utilization.

Main Methods:

• A nationwide cohort study utilizing Korea's National Health Information Database and hospital data (1999-2022).
• Analysis of a 1.7 million adult cohort to estimate nationwide rates of non-reimbursed LDCT screening.
• Joinpoint regression used to assess trends in screening, LC incidence, mortality, and healthcare utilization.

Main Results:

• Self-initiated LDCT screening increased significantly in both men and women, far exceeding guideline eligibility.
• Localized-stage LC incidence nearly doubled in women, with a shift towards earlier diagnoses and younger ages.
• Lung surgeries, often without prior biopsy, increased sharply in women, correlating with increased screening.

Conclusions:

• Widespread, guideline-discordant LDCT screening is associated with lung cancer overdiagnosis and increased healthcare utilization, particularly in women.
• Further randomized controlled trials are necessary to evaluate the risks and benefits of screening in low-risk populations.