A Systematic Review of the Harms of Lung Cancer Screening with Low Dose Computed Tomography
Public Deposited- Last Modified
- March 16, 2020
- Creator
-
Schwartz, Cody
- Affiliation: Gillings School of Global Public Health, Public Health Leadership Program
- Abstract
- Background: Lung cancer causes the majority of cancer-related deaths in the United States. Screening for lung cancer with low dose CT (LDCT) has become a prominent topic. This modality has the potential to contribute to a decrease in lung cancer associated mortality. Preliminary data from a large randomized controlled trial have shown a 20% decrease in mortality. Currently, no guidelines endorse LDCT screening for lung cancer. The harms of screening for lung cancer have not been fully characterized in a focused systematic review. Purpose: To explore and characterize the harms associated with low dose CT screening for lung cancer in high risk populations by evaluating the current evidence. This information will assist policy makers and clinicians as they weigh the risks and benefits of screening high risk populations for lung cancer. Data Sources: MEDLINE, EMBASE, Cochrane Library, reviews, reference lists, experts Study Selection: Studies were included that evaluated low dose screening for lung cancer. Those that characterized harms were central to this review. Data Extraction: Data were abstracted to abstraction forms. Studies were graded according to methods used by the United States Preventive Services Task Force (USPSTF). Data Synthesis: Studies reported variable rates of abnormal results with positivity of 8 to 45%. A range of 4 to 55% of total invasive procedures and none to 40% of surgeries were performed for benign indications. Incidental findings were reported in 0.77 to 62% of participants. Of the included studies, 30% discussed anxiety, 55% discussed overdiagnosis, 50% reported morbidity and mortality of workup, and 35% reported false negative cases. False positives at baseline ranged from 86 to 98%. Limitations: This review included observational studies, randomized trials, and systematic reviews of observational studies and short randomized trials. Data from completed large scale randomized trials is currently unavailable. No data from unpublished literature or studies unavailable in English were included so this review has a potential for publication and language bias. Conclusions: The harms of low dose CT screening for lung cancer are poorly reported in screening trials. Even though harms are incompletely characterized in the included studies, these harms are likely clinically significant. Clinicians must weigh the risks and benefits of the screening procedure if they are to implement mass screening for lung cancer with LDCT.
- Date of publication
- August 2011
- DOI
- Resource type
- Rights statement
- In Copyright
- Note
- Track: HC&P
- Paper type: Systematic review
- Advisor
- Harris, Russell
- Degree
- Master of Public Health
- Degree granting institution
- University of North Carolina at Chapel Hill
- Graduation year
- 2011
- Language
- Deposit record
- b6f6bdeb-f0b9-4907-a2ad-769b5d2e1080
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