For patients with high risk of developing lung cancer, is screening by low dose computed tomography (LDCT) effective at reducing cancer-related mortality?

Bottom line:  Low-dose CT screening is associated with a slight (NNT 310) reduction in lung cancer mortality, but uncertainty exists about potential harm of screening.

Summary JAMA.  2012 May 20:1-12. Benefits and Harms of CT Screening for Lung Cancer: A Systematic ReviewBenefits and Harms of CT Screening for Lung Cancer. Bach PB, et al.
Systematic review of 8 RCTs and 13 cohort studies of LDCT screening that reported lung cancer−specific or all-cause mortality, nodule detection rate, frequency of additional imaging, frequency of invasive diagnostic procedures, or complications from evaluation of suspected lung cancer.  RESULTS:  3 RCTs reported lung cancer mortality.  The control in one study was chest radiograph and the control in the other two studies was usual care.  Table 3 summarizes rates of lung cancer mortality and all-cause mortality (N>30,000).

The NLST study (n >53,000) found that 3 annual rounds of screening (baseline and 1 and 2 years later) with LDCT would require 310 individuals to participate in screening for the t 3 rounds in order to prevent 1 lung cancer death.

The ongoing DANTE (n=2472) and DLCST studies randomized patients to 5 annual rounds of LDCT screening or usual care.  A median follow-up of 34 and 58 months of follow-up, respectively, showed no statistically significant difference in lung cancer mortality DANTE: relative risk, 0.97,  P = .84; and DLCST: RR, 1.15, P = .43).

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About Amy

Clinical Informationist at EUH Branch Library
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