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Low-dose CT screening of smokers decreases lung cancer deaths, but not overall mortality
Clinical Question
Does low-dose computerized tomography lung cancer screening prevent mortality in smokers?
Bottom line
Overall, low-dose computerized tomography (LDCT) screening of smokers to identify lung cancer before symptoms present decreases the risk of dying from lung cancer, but not overall mortality. The likelihood of a lung cancer–related death only drops from 2.2% to 1.8% over the subsequent 5 to 10 years. 1a
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Government
Setting: Various (meta-analysis)
Synopsis
These investigators identified studies by using the 5 previous systematic reviews and then searching 4 databases to find additional English-language randomized trails, including the recently published NELSON trial. They identified 9 studies enrolling 96,559 patients. Most of the patients (72%), though, came from just 2 trials, the NELSON trial conducted in the Netherlands and the NLST study conducted in the United States. The risk of bias for the studies was low, as was the heterogeneity among the studies. Overall, screening for lung cancer decreased the likelihood of death due to lung cancer. The actual difference in lung cancer rates over 5 to 10 years of study was very small, however: 2.2% of the unscreened group died of lung cancer as compared with 1.8% of the screened group (0.4% actual reduction). The effect was more evident in women. Overall mortality was not impacted by screening. Approximately 8% of screened patients were overdiagnosed, meaning they were diagnosed with lung cancer that would never have been apparent in their lifetimes had they not been screened.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
overall mortality
if this remained constant, what increased?
Screening for lung cancer?
Trivial benefit in reducing mortality from lung cancer versus harm from biopsies and overdiagnosis of indolent cancers = Shared decision-making
good information
Good review