Annals of Internal Medicine

Alfred I. Neugut, Melissa K. Accordino. Ann Intern Med. 18 September 2012;157(6):JC3-6

Question:
What are the benefits and risks of lung cancer screening with low-dose computed tomography (LDCT) in patients at increased risk for lung cancer due to smoking and age?

Review scope:
Included studies evaluated LDCT screening for lung cancer and reported ≥ 1 of the following outcomes: lung cancer−specific or all-cause mortality, nodule detection rate, frequency of additional imaging, frequency of invasive diagnostic procedures (e.g., needle or bronchoscopic biopsy, surgical biopsy, or surgical resection), complications from evaluation of suspected lung cancer, or rate of smoking cessation or reinitiation. Exclusion criteria were studies with risk factors other than smoking, and meta-analyses or case reports of patients diagnosed with lung cancer.

Review methods:
MEDLINE, EMBASE/Excerpta Medica, and Cochrane Library (all to Apr 2012); and reference lists of related articles and reviews were searched for published, English-language, randomized, controlled trials (RCTs) or cohort studies. 8 RCTs (n = 83 331, lower age range 47 to 60 y, upper age range 69 to 80 y; 55% to 100% men; ≥ 15 to ≥ 30 pack-y of smoking; < 10 to ≤ 15 y since smoking cessation) and 13 cohort studies met inclusion criteria. Only the results of RCTs are reported in this abstract. 5 RCTs compared LDCT with no screening and 3 with chest radiography. 4 RCTs reported preliminary data only. 3 RCTs reported mortality. Data were not pooled.

Main results:
CT screening reduced risk for all-cause and lung cancer mortality more than chest radiography in the largest trial; CT screening and usual care did not differ in 2 trials (Table). Average nodule detection rate across 8 RCTs was 20% (range 3% to 30%); in 6 RCTs, including all 3 comparing LDCT with chest radiography, > 90% of nodules were benign.

Conclusion:
In patients at increased risk for lung cancer, low-dose computed tomography screening for lung cancer detection reduced lung cancer–specific and all-cause mortality more than chest radiography in 1 large trial but showed no effect compared with usual care in 2 smaller trials.

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