Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2013 Jun 21;2013(6):CD001991.
doi: 10.1002/14651858.CD001991.pub3.

Screening for lung cancer

Renée Manser  1 , Anne Lethaby, Louis B Irving, Christine Stone, Graham Byrnes, Michael J Abramson, Don Campbell
Affiliations
Meta-Analysis

Screening for lung cancer

Renée Manser et al. Cochrane Database Syst Rev. .

Abstract

Background: This is an updated version of the original review published in The Cochrane Library in 1999 and updated in 2004 and 2010. Population-based screening for lung cancer has not been adopted in the majority of countries. However it is not clear whether sputum examinations, chest radiography or newer methods such as computed tomography (CT) are effective in reducing mortality from lung cancer.

Objectives: To determine whether screening for lung cancer, using regular sputum examinations, chest radiography or CT scanning of the chest, reduces lung cancer mortality.

Search methods: We searched electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 5), MEDLINE (1966 to 2012), PREMEDLINE and EMBASE (to 2012) and bibliographies. We handsearched the journal Lung Cancer (to 2000) and contacted experts in the field to identify published and unpublished trials.

Selection criteria: Controlled trials of screening for lung cancer using sputum examinations, chest radiography or chest CT.

Data collection and analysis: We performed an intention-to-screen analysis. Where there was significant statistical heterogeneity, we reported risk ratios (RRs) using the random-effects model. For other outcomes we used the fixed-effect model.

Main results: We included nine trials in the review (eight randomised controlled studies and one controlled trial) with a total of 453,965 subjects. In one large study that included both smokers and non-smokers comparing annual chest x-ray screening with usual care there was no reduction in lung cancer mortality (RR 0.99, 95% CI 0.91 to 1.07). In a meta-analysis of studies comparing different frequencies of chest x-ray screening, frequent screening with chest x-rays was associated with an 11% relative increase in mortality from lung cancer compared with less frequent screening (RR 1.11, 95% CI 1.00 to 1.23); however several of the trials included in this meta-analysis had potential methodological weaknesses. We observed a non-statistically significant trend to reduced mortality from lung cancer when screening with chest x-ray and sputum cytology was compared with chest x-ray alone (RR 0.88, 95% CI 0.74 to 1.03). There was one large methodologically rigorous trial in high-risk smokers and ex-smokers (those aged 55 to 74 years with ≥ 30 pack-years of smoking and who quit ≤ 15 years prior to entry if ex-smokers) comparing annual low-dose CT screening with annual chest x-ray screening; in this study the relative risk of death from lung cancer was significantly reduced in the low-dose CT group (RR 0.80, 95% CI 0.70 to 0.92).

Authors' conclusions: The current evidence does not support screening for lung cancer with chest radiography or sputum cytology. Annual low-dose CT screening is associated with a reduction in lung cancer mortality in high-risk smokers but further data are required on the cost effectiveness of screening and the relative harms and benefits of screening across a range of different risk groups and settings.

PubMed Disclaimer

Conflict of interest statement

None known. The authors of this review were not involved in any of the primary studies included in the review.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Lung cancer screening with chest radiography +/‐ sputum cytology versus less intense screening, Outcome 1 Lung cancer mortality.
1.2
1.2. Analysis
Comparison 1 Lung cancer screening with chest radiography +/‐ sputum cytology versus less intense screening, Outcome 2 Lung cancer mortality (including prolonged follow‐up data).
1.3
1.3. Analysis
Comparison 1 Lung cancer screening with chest radiography +/‐ sputum cytology versus less intense screening, Outcome 3 All‐cause mortality.
1.4
1.4. Analysis
Comparison 1 Lung cancer screening with chest radiography +/‐ sputum cytology versus less intense screening, Outcome 4 Lung cancer 5‐year survival.
2.1
2.1. Analysis
Comparison 2 Annual chest x‐ray screening versus usual care (no regular screening), Outcome 1 Lung cancer mortality at 6 years of follow up.
2.2
2.2. Analysis
Comparison 2 Annual chest x‐ray screening versus usual care (no regular screening), Outcome 2 Lung cancer mortality at 13 years of follow up.
2.3
2.3. Analysis
Comparison 2 Annual chest x‐ray screening versus usual care (no regular screening), Outcome 3 Deaths from all causes (excluding deaths from PLCO cancers).
3.1
3.1. Analysis
Comparison 3 Annual low dose CT screening versus annual chest x‐ray, Outcome 1 Lung cancer mortality.
3.2
3.2. Analysis
Comparison 3 Annual low dose CT screening versus annual chest x‐ray, Outcome 2 All‐cause mortality.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Czech Study {published data only}
    1. Kubik A. Risk groups and effective frequency of X‐ray miniature screening of bronchial carcinoma [Risikogruppen und effektive schirmbildscreeningfrequenz des bronchialkrebses]. Zeitchrift fu Erankungen de Atmungsovgane 1983;160(1):18‐25. - PubMed
    1. Kubik A, Haerting J. Survival and mortality in a randomised study of lung cancer detection. Neoplasma 1990;37(4):467‐75. - PubMed
    1. Kubik A, Parkin DM, Khlat M, Erban J, Polak J. Adamec M. Lack of benefit from semi‐annual screening for cancer of the lung: follow‐up report of a randomised controlled trial on a population of high‐risk males in Czechoslavakia. International Journal of Cancer 1990;45(1):26‐33. - PubMed
    1. Kubik A, Polak J. Lung cancer detection. Results of a randomized prospective study in Czechoslovakia. Cancer 1986;57:2427‐37. - PubMed
    1. Kubik, AK, Parkin DM, Zatioukal P. Czech study on lung cancer screening: Post‐trial follow up of lung cancer deaths up to year 15 since enrolment. Cancer 2000;89(Suppl):2363‐8. - PubMed
Erfurt County Study {published data only}
    1. Wilde J. A 10 year follow‐up of semi‐annual screening for early detection of lung cancer in the Erfurt County,GDR. European Respiratory Journal 1989;2(7):656‐62. - PubMed
    1. Wilde J, Durschmied H, Lorenz H, Niegsch G, Schmidt H, Simer HM. Effectiveness of photography screening studies in the early detection of bronchial carcinoma [Effektivitat der schirmbildreihenuntersuchung zur fuhen erfassung des brondhialkarzinoms]. Zeitschrift fur Erkrankigender Atmungsorgane 1983;160:128‐41. - PubMed
Johns Hopkins Study {published data only}
    1. Baker R, Tockman MS, Marsh BR, Stitik FP, Ball WC, Eggleston JC, et al. Screening for bronchogenic carcinoma: the surgical experience. Journal of Thoracic Cardiovascular Surgery 1979;78:876‐82. - PubMed
    1. Frost NK, Ball WC, Levin ML, Tockman MS, Baker RR, Carter D, et al. Early lung cancer detection: results in the initial (prevalence) radiologic and cytologic screening in the Johns Hopkins Study. American Review of Respiratory Disease 1984;130:549‐54. - PubMed
    1. Levin ML, Tockman MS, Frost JK, Ball WC. Lung cancer mortality in males screened by chest x‐ray and cytologic sputum examination: a preliminary report. Recent Results in Cancer Research 1982;82:138‐46. - PubMed
    1. Stitik FP, Tockman MS. Radiographic screening in the early detection of lung cancer. Radiologic Clinics of North America. 1978;16(3):347‐66. - PubMed
    1. Tockman MS. Survival and mortality from lung cancer in a screened population. Chest 1986;89(Suppl):324‐5.
Kaiser Foundation Study {published data only}
    1. Dales L, Friedman GD, Collen MF. Evaluating periodic multiphasic health checkups: a controlled trial. Journal of Chronic Diseases 1979;32:385‐404. - PubMed
    1. Friedman G, Collen MF, Fireman BH. Multiphasic health checkup evaluation: a 16 year follow up. Journal of Chronic Diseases 1986;39:453‐63. - PubMed
Mayo Lung Project {published data only}
    1. Flehinger BJ, Kimmel M, Polyak T, Melamed MR. Screening for lung cancer. The Mayo Lung Project revisited. Cancer 1993;72(5):1573‐80. - PubMed
    1. Fontana RS, Sanderson DR, Taylor WF, Woolner LB, Miller WE, Muhm JR, et al. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo clinic study. American Review of Respiratory Diseases 1984;130:561‐5. - PubMed
    1. Fontana RS, Sanderson DR, Woolner LB, Miller WE, Bernatz PE, Payne WS, et al. The Mayo Lung Project for early detection and localization of bronchogenic carcinoma: a status report. Chest 1975;67(5):511‐22. - PubMed
    1. Fontana RS, Sanderson DR, Woolner LB, Taylor WF, Miller WE, Muhm JR. Lung cancer screening: the Mayo program. Journal of Occupational Medicine 1986;28(8):746‐50. - PubMed
    1. Fontana RS, Sanderson DR, Woolner LB, Taylor WF, Miller WE, Muhm JR, et al. Screening for lung cancer: a critique of the Mayo Lung Project. Cancer 1991;67(4 Suppl):1155‐64. - PubMed
Mem Sloan‐Kettering {published data only}
    1. Flehinger BJ, Kimmel M. The natural history of lung cancer in a periodically screened population. Biometrics 1987;43:127‐44. - PubMed
    1. Flehinger BJ, Melamed MR. Current status of screening for lung cancer. Chest Surgery Clinics of North America 1994;4(1):1‐15. - PubMed
    1. Flehinger BJ, Melamed MR, Zaman MB, Heelan RT, Perchick WB, Martini N. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Memorial Sloan‐Kettering study. American Review of Respiratory Diseases 1984;130(4):555‐60. - PubMed
    1. Heelan RT, Flehinger BJ, Melamed MR, Zaman MB, Perchick WB, Caravelli JF, et al. Non‐small‐cell lung cancer: results of the New York screening program. Radiology 1984;151:289‐93. - PubMed
    1. Martini N. Results of the Memorial Sloan‐Kettering study in screening for early lung cancer. Chest 1986;89(4 Suppl):325. - PubMed
North American NLST {published data only}
    1. National Lung Screening Trial Research Team. Reduced lung‐cancer mortality with low‐dose computed tomographic screening. New England Journal of Medicine 2011;365(5):395‐409. - PMC - PubMed
    1. National Lung Screening Trial Research Team. The National Lung Screening Trial: overview and study design. Radiology 2011;258(1):243‐53. - PMC - PubMed
North London Study {published data only}
    1. Anon. Lung cancer detection by chest x‐rays at 6 monthly intervals. Nova Scotia Medical Bulletin 1970;49(1):14‐5. - PubMed
    1. Brett G. The presymptomatic diagnosis of lung cancer. Proceedings of the Royal Society of Medicine 1966;59:1208. - PMC - PubMed
    1. Brett G. The value of lung cancer detection by 6 monthly chest radiographs. Thorax 1968;23:414‐20. - PMC - PubMed
    1. Brett GZ. Earlier diagnosis and survival in lung cancer. British Medical Journal 1969;4(678):260‐2. - PMC - PubMed
PLCO Trial {published data only}
    1. Hocking WG, Hu P, Oken MM, Winslow SD, Kvale PA, Prorok PC, et al. Lung cancer screening in the randomized Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Journal of the National Cancer Institute 2010;102(10):722‐31. - PMC - PubMed
    1. Kramer BS, Gohagan J, Prorok PC. A randomised study of chest x‐ray screening for lung cancer as part of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Trial.. Lung Cancer 1994;11(Suppl 2):82‐3.
    1. Oken MM, Marcus PM, Hu P, Beck TM, Hocking Wm Kvale PA, et al. Baseline chest radiograph for lung cancer detection in the randomized Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Journal of the National Cancer Institute 2005;97(24):1832‐9. - PubMed
    1. Oken, MM, Hocking WG, Kvale PA, Andriole GL, Buys SS, Church TR, et al. Screening by chest radiograph and lung cancer mortality. The Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized trial. JAMA 2011;306(17):1865‐73. - PubMed
    1. Prorok PC, Andriole GL, Bresalier RS, Buys SS, Chia D, Crawford ED, et al. Design of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Controlled Clinical Trials 2000;21:273S‐309S. - PubMed

References to studies excluded from this review

Bach 2007 {published data only}
    1. Bach PB, Jett JR, Pastorino U, Tockman MS, Swensen SJ, Begg CB. Computed tomography screening and lung cancer outcomes. JAMA 2007; Vol. 297, issue 9:953‐61. - PubMed
Depiscan Group {published data only}
    1. Blanchon T, Bréchot J‐M, Grenier PA, Ferretti GR, Lemarié E, Milleron B, et al. Baseline results of the Depiscan study: A French randomized pilot trial of lung cancer screening comparing low dose CT scan (LDCT) and chest x‐ray (CXR). Lung Cancer 2007;58:50‐8. - PubMed
Diederich 2000 {published data only}
    1. Diederich S, Wormanns D, Lenzen H, Semik M, Thomas M, Peters PE. Screening for asymptomatic early bronchogenic carcinoma with low dose CT of the Chest. Cancer 2000;89(Suppl):2483‐4. - PubMed
Diederich 2002 {published data only}
    1. Diederich S, Wormanns D, Semik M, Thomas M, Lenzen H, Roos N, et al. Screening for early lung cancer with low‐dose spiral CT: prevalence in 817 asymptomatic smokers. Radiology 2002;222(3):773‐81. - PubMed
Ebeling 1987 {published data only}
    1. Ebeling K, Nischan P. Screening for lung cancer ‐ results from a case‐control study. International Journal of Cancer 1987;40(2):141‐4. - PubMed
Garg 2002 {published data only}
    1. Garg K, Keith RL, Byers T, Kelly K, Kerzner AL, Lynch DA, et al. Randomized controlled trial with low‐dose spiral CT for lung cancer screening: feasibility study and preliminary results. Radiology 2002;225(2):506‐10. - PubMed
Gohagan 2005 {published data only}
    1. Gohagan JK, Marcus PM, Fagerstrom RM, Pinsky PF, Kramer BS, Prorok PC, et al. Final results of the Lung Screening Study, a randomised feasibility study of spiral CT versus chest X‐ray screening for lung cancer. Lung Cancer 2005;47:9‐15. - PubMed
Henschke 1999 {published data only}
    1. Henschke CI, McCauley DI, Yankelevitz DF, Naidich DP, McGuinness G, Miettinen OS, et al. Early lung cancer action project: overall design and findings from baseline screening. Lancet 1999;354:99‐105. - PubMed
Henschke 2001 {published data only}
    1. Henschke C, Naidich DP, Yankelevitz DF, McGuinness G, McCauley DI, Smith JP, et al. Early Lung Cancer Action Project: initial findings on repeat screening. Cancer 2001;92:153‐9. - PubMed
Henschke 2006 {published data only}
    1. Henschke CI, Yankelevitz DF, Libby DM, Pasmantier MW, Smith JP, Miettinen OS. Survival of patients with stage 1 lung cancer detected on CT screening. New England Journal of Medicine 2006;355(17):1763‐71. - PubMed
Kakinuma 1999 {published data only}
    1. Kakinuma R, Ohmatsu H, Kaneko M, Eguchi K, Naruke T, Nagai K, et al. Detection failures in spiral CT screening for lung cancer: analysis of CT findings. Radiology 1999;212:61‐6. - PubMed
Kaneko 1996 {published data only}
    1. Kaneko M, Eguchi K, Ohmatsu H, Kakinuma R, Naruke T, Suemasa K, et al. Peripheral lung cancer: screening and detection with low‐dose spiral CT versus radiography. Radiology 1996;201(3):798‐802. - PubMed
Matsumoto 1995 {published data only}
    1. Matsumoto M, Horikoshi H, Moteki T, Hatori N, Tateno Y, Iinuma T, et al. A pilot study with lung‐cancer screening CT (LSCT) at the secondary screening for lung cancer detection. Nippon Igaku Hoshasen Gakkai Zasshi [Nippon Acta Radiologica] 1995;55(3):172‐9. - PubMed
Nawa 2002 {published data only}
    1. Nawa T, Nakagawa T, Kusano S, Kawasaki Y, Sugawara Y, Nakata H. Lung cancer screening using low‐dose spiral CT: results of baseline and 1‐year follow‐up studies. Chest 2002;122:15‐20. - PubMed
Sobue 1992 {published data only}
    1. Sobue T, Suzuki T, Naruke T, Japanese lung‐cancer‐screening research group. A case control study for evaluating lung cancer screening in Japan. International Journal of Cancer 1992;50(2):230‐7. - PubMed
Sobue 2002 {published data only}
    1. Sobue T, Moriyama N, Kaneko M, Kusumoto M, Kobayashi T, Tsuchiya R, et al. Screening for lung cancer with low‐dose helical computed tomography: Anti‐Lung Cancer Association project. Journal of Clinical Oncology 2002;20(4):911‐20. - PubMed
Sone 1998 {published data only}
    1. Sone S, Takashima S, Li F, Yang Z, Honda T, Maruyama Y, et al. Mass screening for lung cancer with mobile spiral computed tomography scanner. Lancet 1998;351(9111):1242‐5. - PubMed
Sone 2001 {published data only}
    1. Sone S, Li F, Yang Z‐G, Honda T, Maruyama Y, Takashima S, et al. Results of three‐year mass screening programme for lung cancer using mobile low‐dose spiral computed tomography scanner. British Journal of Cancer 2001;84(1):25‐32. - PMC - PubMed
Swensen 2002 {published data only}
    1. Swensen SJ, Jett JR, Sloan JA, Midthun DE, Hartman TE, Sykes AM, et al. Screening for lung cancer with low‐dose spiral computed tomography. American Journal of Respiratory and Critical Care Medicine 2002;165:508‐13. - PubMed
Tiitola 2002 {published data only}
    1. Tiitola M, Kivisaari L, Huuskonen MS, Mattson K, Koskinen H, Lehtola H, et al. Computed tomography screening for lung cancer in asbestos‐exposed workers. Lung Cancer 2002;35:17‐22. - PubMed
Yang 2008 {published data only}
    1. Yang M, Wang J, Meng L‐J, Wang Y, Xu L, Liu F‐Y, et al. Analysis of feasibility of lung cancer screening with low‐radiation‐dose spiral CT scan plus detection of p16 gene methylation in serum. Chinese Journal of Cancer Prevention and Treatment 2008;15(1):8‐10.

References to ongoing studies

DANTE {published data only}
    1. Infante M, Cavuto S, Lutman FR, Brambilla G, Chiesa G Ceresoli G, et al. A randomized study of lung cancer screening with spiral computed tomography: three‐year results from the DANTE trial. American Journal of Respiratory and Critical Care Medicine 2009;180:445‐53. - PubMed
DLCST {published data only}
    1. Saghir Z, Dirksen A, Ashraf H, Bach KS, Brodersen J, Clemensten PF, et al. CT screening for lung cancer brings forward early disease. The Randomised Danish Lung Cancer Screening Trial: status after five annual screening rounds with low‐dose CT. Thorax 2012;67:296‐301. - PubMed
ITALUNG {published data only}
    1. Pegna AL, Picozzi G, Mascalchi M, Carrozzi FM, Carozzi L, Comin C, et al. Design, recruitment and baseline results of the ITALUNG trial for lung cancer screening with low‐dose CT. Lung Cancer 2009;64:34‐40. - PubMed
LUSI {published data only}
    1. Becker N, Motsch E, Gross ML, Eigentopf A, Heussel CP, Dienemann H, et al. Randomized study on early detection of lung cancer with MSCT in Germany: study design and results of the first screening round. Journal of Cancer Research and Clinical Oncology 2012;138(9):1475‐86. - PubMed
MILD {published data only}
    1. Pastorino U, Rossi M, Rosato V, Marchianò A, Sverzellati N, Morosi C, et al. Annual or biennial CT screening versus observation in heavy smokers: 5 year results of the MILD trial. European Journal of Cancer Prevention 2012;21:308‐15. - PubMed
NELSON 2003 {published data only}
    1. Lersel CA, Koning HJ, Draisma G, Mali WP, Scholten ET, Nackaerts K, et al. Risk‐based selection from the general population in a screening trial: selection criteria, recruitment and power for the Dutch‐Belgian Randomised Lung Cancer Multi‐slice CT Screening Trial (NELSON). International Journal of Cancer 2006;120:868‐74. - PubMed
    1. Zhao, YR, Xie X, Koning HJ, Mali WP, Vliegenthart R, Oudkerk M. NELSON lung cancer screening study. Cancer Imaging 2011;11:S79‐S84. - PMC - PubMed

Additional references

ACS 1980
    1. American Cancer Society. Report on the cancer related health checkup: cancer of the lung. CA: A Cancer Journal for Clinicians 1980;30:199‐207.
Bach 2007a
    1. Bach PB, Silvestri GA, Hauger M, Jett JR. Screening for lung cancer. ACCP evidence‐based clinical practice guidelines. Chest 2007;132(2 Suppl):69S‐77S. - PubMed
Bailar 1984
    1. Bailar JC. Screening for lung cancer ‐ where are we now?. Am Rev Respir Dis 1984;130(4):541‐2. - PubMed
Bailar 1997
    1. Bailar J, Gornick HL. Cancer undefeated. New England Journal of Medicine 1997;336:1569‐74. - PubMed
Berlin 1984
    1. Berlin I, Buncher CR, Fontana RS, Frost JK, Melamed MR. The National Cancer Institute cooperative early lung cancer detection program. Results of the initial screen (prevalence). Early lung cancer detection: introduction. American Review of Respiratory Disease 1984;130(4):545‐9. - PubMed
Black 2000
    1. Black WC. Overdiagnosis: an under recognised cause of confusion and harm in cancer screening. Journal of the National Cancer Institute 2000;92(16):1280‐2. - PubMed
Bland 1995
    1. Bland J, Altman DG. Multiple significance tests: the Bonferroni method. BMJ 1995;310:170. - PMC - PubMed
Boshuizen 2012
    1. Boshuizen R, Kuhn P, Heuvel M. Circulating tumor cells in non‐small cell lung carcinoma. Journal of Thoracic Disease 2012;4(5):456‐8. - PMC - PubMed
Brenner 2004
    1. Brenner DJ. Radiation risks potentially associated with low‐dose CT screening in adult smokers for lung cancer. Radiology 2004;231:440‐5. - PubMed
Carpagnano 2005
    1. Carpagnano GE, Foschino‐Barbaro MP, Spanevello A, Resta O, Carpagnano F, Mulé G, et al. 3p microsatellite alterations in exhaled breath condensate from patients with non‐small cell lung cancer. American Journal of Respiratory Critical Care Medicine 2005;172:738‐44. - PubMed
Chalmers 1983
    1. Chalmers TC, Celano P, Sacks HS, Smith H Jr. Bias in treatment assignment in controlled clinical trials. New England Journal of Medicine 1983;309:1358‐61. - PubMed
Cochrane Handbook
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Diederich 2000b
    1. Diederich S, Lenzen H. Radiation exposure associated with imaging of the chest. Cancer 2000;89(Supplement):2457‐60. - PubMed
Dominion 2011
    1. Dominion L, Poli A, Montovani W, Rotolol N, Imperatori A. Volunteer effect and compromised randomisation in the Mayo Project of screening for lung cancer. European Journal of Epidemiology 2011;26:79‐80. - PMC - PubMed
Doria‐Rose 2009
    1. Doria‐Rose VP, Marcus PM, Szabo E, Tockman MS, Melamed MR, Prorok PC. Randomized controlled trials of the efficacy of lung cancer screening by sputum cytology revisited: a combined mortality analysis from the Johns Hopkins Lung Project and the Memorial Sloan‐Kettering Lung Study. Cancer 2009;115:5007‐17. - PMC - PubMed
Eddy 1989
    1. Eddy DM. Screening for lung cancer. Annals of Internal Medicine 1989;111(3):232‐7. - PubMed
Fontana 1984
    1. Fontana RS, Sanderson DR, Taylor WF, Woolner LB, Miller WE, Muhm JR, et al. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo clinic study. American Review of Respiratory Disease 1984;130(4):561‐5. - PubMed
Globocan 2008
    1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008 v2.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10. Lyon, France: International Agency for Research on Cancer; 2010. Available from: http://globocan.iarc.fr (accessed 29th December 2012).
Godoy 2012
    1. Godoy MC, Sabloff B, Naidich DP. Subsolid pulmonary nodules: imaging evaluation and strategic management. Current Opinion in Pulmonary Medicine 2012;18(4):304‐12. - PubMed
Halpern 1993
    1. Halpern M, Gillespie BW, Warner KE. Patterns of absolute risk of lung cancer mortality in former smokers. Journal of the National Cancer Institute 1993;85:457‐63. - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SJ, Deeks JJ, Altman DJ. Measuring inconsistencies in meta‐analyses. BMJ 2003;327:557‐560. - PMC - PubMed
Jemal 2009
    1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics 2009. CA: A Cancer Journal for Clinicians 2009;59:225‐49. - PubMed
Kernan 1999
    1. Kernan WN, Viscoli CM, Makuch RW, Brass LM, Horwitz RI. Stratified randomisation for clinical trials. Journal of Clinical Epidemiology 1999;52:19‐26. - PubMed
Kerry 1998
    1. Kerry SM, Bland JM. Analysis of a trial randomised in clusters. BMJ 1998;316:54. - PMC - PubMed
Kubik 1986
    1. Kubik AP, Polak J. Lung cancer detection. Results of a randomised prospective study in Czechoslovakia. Cancer 1986;57:2427‐37. - PubMed
Lopez 1995
    1. Lopez A. The lung cancer epidemic in developed countries. Adult mortality in developed countries: from description to explanation. Oxford: Clarendon Press, 1995:111‐34.
Ma 2013
    1. Ma J, Ward EM, Smith R, Jemal A. Annual number of lung cancer deaths potentially avertable by screening in the United States. Cancer 2013;119:1381‐5. - PubMed
Machado 2005
    1. Machado RF, Laskowski D, Deffenderfer O, Burch T, Zheng S, Mazzone PJ, et al. Detection of lung cancer by sensor array analyses of exhaled breath. American Journal of Respiratory Critical Care Medicine 2005;171:1286‐91. - PMC - PubMed
Mahadevia 2003
    1. Mahadevia PJ, Fleisher LA, Frick KD, Eng J, Goodman SN, Powe NR. Lung cancer screening with helical computed tomography in older adult smokers: a decision and cost‐effectiveness analysis. JAMA 2003;289(3):313‐22. - PubMed
Mong 2011
    1. Mong C, Garon EB, Fuller C, Mahtabifard A, Mirocha J, Mosenifar Z, et al. High prevalence of lung cancer in a surgical cohort of lung cancer patients a decade after smoking cessation.. Journal of Cardiothoracic Surgery 2011;6:19. - PMC - PubMed
Patz 2000
    1. Patz E, Goodman PC, Bepler G. Screening for lung cancer. New England Journal of Medicine 2000;343:1627‐33. - PubMed
Peto 1976
    1. Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, et al. Design and analysis of randomised clinical trials requiring prolonged observation of each patient. British Journal of Cancer 1976;34:585. - PMC - PubMed
Phillips 1999
    1. Phillips M, Gleeson K, Hughes JM, Greenberg J, Cataneo RN, Baker L, et al. Volatile organic compounds in breath as markers for lung cancer: a cross sectional study. Lancet 1999;353:1930‐3. - PubMed
Phillips 2003
    1. Phillips M, Cataneo RN, Cummin AR, Gagliardi AJ, Gleeson K, Greenberg J, et al. Detection of lung cancer with volatile markers in the breath. Chest 2003;123:2115‐23. - PubMed
Rahman 2005
    1. Rahman SM, Shyr Y, Yildiz PB, Gonzalez AL, Li H, Zhang X, et al. Proteomic patterns of preinvasive bronchial lesions. American Journal of Respiratory Critical Care Medicine 2005;172(12):1556‐62. - PMC - PubMed
Raji 2012
    1. Raji OY, Duffy SW, Agbaje OF, Baker SG, Christiani DC, Cassidy A, et al. Predictive accuracy of the Liverpool Lung Project risk model for stratifying patients for computed tomography screening for lung cancer: a case‐control and cohort validation study. Annals of Internal Medicine 2012;157(4):242‐50. - PMC - PubMed
RevMan 2008 [Computer program]
    1. The Nordic Cochrane Centre. The Cochrane Collaboration. Review Manager (RevMan). Version 5.2. Copenhagen: The Nordic Cochrane Centre. The Cochrane Collaboration, 2008.
Ries 1994
    1. Ries LA. Influence of extent of disease, histology and demographic factors on lung cancer survival in the seer population‐based data. Seminars in Surgical Oncology 1994;10(1):21‐30. - PubMed
Schoenborn 2013
    1. Schoenborn CA, Adams PF, Peregoy JA. Health behaviors of adults: United States, 2008–2010. National Center for Health Statistics. Vital Health Statistics 2013;10(257):21‐4. - PubMed
Schulz 1995
    1. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273:408‐12. - PubMed
Tockman 1986
    1. Tockman MS. Survival and mortality from lung cancer in a screened population. Chest 1986;89:S324‐S325.
Tockman 1987
    1. Tockman M, Anthonisen NR, Wright EC, Donithan MG. Airways obstruction and the risk for lung cancer. Annals of Internal Medicine 1987;106:512‐8. - PubMed
Travis 2011
    1. Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. Journal of Thoracic Oncology 2011;6(2):244‐85. - PMC - PubMed
Welch 2007
    1. Welch HG, Woloshin S, Schwartz LM, Gordis L, Gotzsche PC, Harris R, et al. Overstating the evidence for lung cancer screening. Archives of Internal Medicine 2007;167(21):2289‐95. - PubMed
Welch 2010
    1. Welch HG, Black WC. Overdiagnosis in cancer. Journal of the National Cancer Institute 2010;102:605‐13. - PubMed
WHO 2008
    1. World Health Organization. The top 10 causes of death. World Health Organization , Media Centre, Fact Sheet 310 (updated June 2011). Available at www.who.int/mediacentre/factsheets/fs310/en/index.html (accessed 26th January 2013).
Wilde 1989
    1. Wilde J. A 10 year follow‐up of semi annual screening for for early detection of lung cancer in the Efurt County, GDR. European Respiratory Journal 1989;2(7):656‐62. - PubMed
Wilson 2008
    1. Wilson DO, Weissfeld JL, Balkan A, Schragin JG, Fuhrman CR, Fisher SN, et al. Association of radiographic emphysema and airflow obstruction with lung cancer. American Journal of Respiratory and Critical Care Medicine 2008;178(7):738‐44. - PMC - PubMed
Woo 1985
    1. Woo B, Woo B, Cook EF, Weisberg M, Goldman L. Screening procedures in the asymptomatic adult: comparison of physicians' recommendations, patients' desires, published guidelines and actual practice. JAMA 1985;254:1480‐4. - PubMed
Young 2012
    1. Young RP, Hopkins RJ. Diagnosing COPD and targeted lung cancer screening (correspondence). European Respiratory Journal 2012;40(4):1063‐4. - PubMed
Zhong 2005
    1. Zhong L, Hidalgo GE, Stromberg AJ, Khattar NH, Jett JR, Hirschowitz EA. Using protein microarray as a diagnostic assay for non‐small cell lung cancer. American Journal of Respiratory Critical Care Medicine 2005;172:1308‐14. - PMC - PubMed

References to other published versions of this review

Manser 1999
    1. Manser RL, Irving LB, Stone C, Byrnes G, Abramson M, Campbell D. Screening for lung cancer. Cochrane Database of Systematic Reviews 1999, Issue 3. [DOI: 10.1002/14651858.CD001991] - DOI - PubMed
Manser 2004
    1. Manser R, Irving LB, Stone C, Byrnes G, Abramson MJ, Campbell D. Screening for lung cancer. Cochrane Database of Systematic Reviews 2004, Issue 1. [DOI: 10.1002/14651858.CD001991.pub2] - DOI - PubMed
Manser 2010
    1. Manser R, Irving LB, Stone C, Byrnes G, Abramson MJ, Campbell D. Screening for lung cancer. Cochrane Database of Systematic Reviews 2004, Issue 1. [DOI: 10.1002/14651858.CD001991.pub2] - DOI - PubMed

LinkOut - more resources