Lung cancer screening with low-dose computed tomography extract
Mortality-related benefits are primarily countered by harm from false-positive screening results and overdiagnoses. Due to false-positive screening results, a minimum of 1 of 1000 persons and a maximum of 15 of 1000 persons undergo invasive procedures which would not have been performed without the...
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| Format: | eBook |
| Language: | English |
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Köln, Germany
Institute for Quality and Efficiency in Health Care
2020, 19 October 2020
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| Edition: | Version 1.0 |
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| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Mortality-related benefits are primarily countered by harm from false-positive screening results and overdiagnoses. Due to false-positive screening results, a minimum of 1 of 1000 persons and a maximum of 15 of 1000 persons undergo invasive procedures which would not have been performed without the screening. These procedures can cause complications, such as pneumothorax. Overdiagnosis are to be considered harm as a result of the associated unnecessary follow-up diagnostics and therapy, including the resulting complications. In the individual studies, the risk of overdiagnosis was between 0 and 22 of 1000 persons invited to the screening. The risk of overdiagnosis based on the people diagnosed with lung cancer during the screening phase is between 0% and 63% in the individual studies. This highlights the importance of maintaining a low risk of overdiagnosis for a favourable benefit-harm relationship. RESEARCH QUESTION: The objective of this investigation is to - assess the benefit of lung cancer screening with low-dose computed tomography (LDCT) in comparison with no (systematic) screening with regard to patient-relevant outcomes in people at elevated risk of lung cancer due to current or past heavy tobacco use. CONCLUSION: There is no proof of any effect of lung cancer screening with LDCT on overall survival when compared with no screening. For lung cancer-specific mortality, there is an indication of a benefit of LDCT screening. Since the respective estimators and associated confidence intervals (CIs) for the absolute effect are of a similar magnitude, screening can be reasonably assumed to also have a favourable effect on all-cause mortality. The joint analysis of these two sub-outcomes therefore results in a hint of benefit of LDCT screening for the outcome of mortality. However, lung cancer screening with LDCT can cause adverse events (hint of harm) and lead to negative consequences via false-positive screening results (proof of harm). Some overdiagnoses occur as well (proof of harm). The studies did not report any data on consequences of false-negative screening results. Their impact on the weighing of benefit and harm is viewed as low. Data from only 1 study were available on the outcome of adverse events, and no usable data were available for the outcome of health-related quality of life. However, the effect of screening on the AE rate and on health-related quality of life is likely reflected in the outcome of overdiagnoses. In comparison with no screening, within 10 years, LDCT screening for lung cancer spares an estimated 5 of 1000 persons (95% CI: [3;8]) death by lung cancer and may possibly extend the life of some of these screening participants. In summary, there is a hint of benefit of LDCT screening versus no screening, and hence, the benefit of LDCT screening outweighs its harm in (former) heavy smokers |
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| Item Description: | Translation of Chapters 1 to 6 of the final report S19-02 Lungenkrebsscreening mittels Niedrigdosis Computertomografie (Version 1.0; Status: 19 October 2020 [German original], 23 December 2020 [English translation]) |
| Physical Description: | 1 PDF file (vi, 48 pages) |