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Meta-Analysis
. 2020 Nov;18(6):545-552.
doi: 10.1370/afm.2582.

Cancer-Specific Mortality, All-Cause Mortality, and Overdiagnosis in Lung Cancer Screening Trials: A Meta-Analysis

Mark H Ebell  1 , Michelle Bentivegna  2 , Cassie Hulme  2
Affiliations
Meta-Analysis

Cancer-Specific Mortality, All-Cause Mortality, and Overdiagnosis in Lung Cancer Screening Trials: A Meta-Analysis

Mark H Ebell et al. Ann Fam Med. 2020 Nov.

Erratum in

  • Corrections.
    [No authors listed] [No authors listed] Ann Fam Med. 2021 Jul-Aug;19(4):292. doi: 10.1370/afm.2692. Ann Fam Med. 2021. PMID: 34264844 Free PMC article. No abstract available.

Abstract

Purpose: Benefit of lung cancer screening using low-dose computed tomography (LDCT) in reducing lung cancer-specific and all-cause mortality is unclear. We undertook a meta-analysis to assess its associations with outcomes.

Methods: We searched the literature and previous systematic reviews to identify randomized controlled trials comparing LDCT screening with usual care or chest radiography. We performed meta-analysis using a random effects model. The primary outcomes were lung cancer-specific mortality, all-cause mortality, and the cumulative incidence ratio of lung cancer between screened and unscreened groups as a measure of overdiagnosis.

Results: Meta-analysis was based on 8 trials with 90,475 patients that had a low risk of bias. There was a significant reduction in lung cancer-specific mortality with LDCT screening (relative risk = 0.81; 95% CI, 0.74-0.89); the estimated absolute risk reduction was 0.4% (number needed to screen = 250). The reduction in all-cause mortality was not statistically significant (relative risk = 0.96; 95% CI, 0.92-1.01), but the absolute reduction was consistent with that for lung cancer-specific mortality (0.34%; number needed to screen = 294). In the studies with the longest duration of follow-up, the incidence of lung cancer was 25% higher in the screened group, corresponding to a 20% rate of overdiagnosis.

Conclusions: This meta-analysis showing a significant reduction in lung cancer-specific mortality, albeit with a tradeoff of likely overdiagnosis, supports recommendations to screen individuals at elevated risk for lung cancer with LDCT.

Keywords: cancer screening; health services; low-dose computed tomography; lung cancer; mass screening; overdiagnosis; preventive medicine; public health.

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Figures

Figure 1.
Figure 1.
Forest plot of lung cancer incidence for trials with 8 or more years of follow-up. DANTE = Detection and Screening of Early Lung Cancer With Novel Imaging Technology; DLCST = Danish Lung Cancer Screening Trial; ITALUNG = Italian Lung Cancer Screening Trial; LUSI = Lung Cancer Screening Intervention; NELSON = Nederlands–Leuvens Longkanker Screenings Onderzoek; RR = relative risk. Note: Weights are from random effects analysis.
Figure 2.
Figure 2.
Forest plot of lung cancer–specific mortality, sorted by shortest to longest median duration of follow-up. DANTE = Detection and Screening of Early Lung Cancer With Novel Imaging Technology; DLCST = Danish Lung Cancer Screening Trial; ITALUNG = Italian Lung Cancer Screening Trial; LSS = Lung Screening Study; LUSI = Lung Cancer Screening Intervention; MILD = Multicentric Italian Lung Detection; NELSON = Nederlands–Leuvens Longkanker Screenings Onderzoek; RR = relative risk. Note: Weights are from random effects analysis.
Figure 3.
Figure 3.
Forest plot of all-cause mortality, sorted by shortest to longest median duration of follow-up. DANTE = Detection and Screening of Early Lung Cancer With Novel Imaging Technology; DLCST = Danish Lung Cancer Screening Trial; ITALUNG = Italian Lung Cancer Screening Trial; LSS = Lung Screening Study; LUSI = Lung Cancer Screening Intervention; MILD = Multicentric Italian Lung Detection; NELSON = Nederlands–Leuvens Longkanker Screenings Onderzoek; RR = relative risk. Note: Weights are from random effects analysis.
See this image and copyright information in PMC

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