Impact of annual trend volume of low-dose computed tomography for lung cancer screening on overdiagnosis, overmanagement, and gender disparities

Abstract

Background: With the increasing prevalence of nonsmoking-related lung cancer in Asia, Asian countries have increasingly adopted low-dose computed tomography (LDCT) for lung cancer screening, particularly in private screening programs. This study examined how annual LDCT volume affects lung cancer stage distribution, overdiagnosis, and gender disparities using a hospital-based lung cancer database.

Methods: This study analyzed the annual utilized LDCT volume, clinical characteristics of lung cancer, stage shift distribution, and potential overdiagnosis. At the individual level, this study also investigated the relationship between stage 0 lung cancer (potential strict definition regarding overdiagnosis) and the clinical characteristics of lung cancer.

Results: This study reviewed the annual trend of 4971 confirmed lung cancer cases from 2008 to 2021 and conducted a link analysis with an LDCT imaging examination database over these years. As the volume of lung cancer screenings has increased over the years, the number and proportion of stage 0 lung cancers have increased proportionally. Our study revealed that the incidence of stage 0 lung cancer increased with increasing LDCT scan volume, particularly during the peak growth period from 2017 to 2020. Conversely, stage 4 lung cancer cases remained consistent across different time intervals. Furthermore, the increase in the lung cancer screening volume had a more pronounced effect on the increase in stage 0 lung cancer cases among females than it had among males. The estimated potential for overdiagnosis brought about by the screening process, compared to non-participating individuals, ranged from an odds ratio of 7.617 to one of 17.114. Both strict and lenient definitions of overdiagnosis (evaluating cases of stage 0 lung cancer and stages 0 to 1 lung cancer) were employed.

Conclusions: These results provide population-level evidence of potential lung cancer overdiagnosis in the Taiwanese population due to the growing use of LDCT screening, particularly concerning the strict definition of stage 0 lung cancer. The impact was greater in the female population than in the male population, especially among females younger than 40 years. To improve lung cancer screening in Asian populations, creating risk-based prediction models for smokers and nonsmokers, along with gender-specific strategies, is vital for ensuring survival benefits and minimizing overdiagnosis.

Keywords: Low-dose computed tomography; Overdiagnosis; Volume trend.

Fig. 1

Flowchart depicting lung cancer register cohort study design to investigate trend analysis, individual and correlation analysis to address the issue of overdiagnosis

Fig. 2

Trends in LDCT examination volumes and percentage of Lung Cancer by Gender from 2008 to 2021

Fig. 3

Trends in LDCT examination volumes and number of stage 0 Lung Cancer from 2008 to 2021

Fig. 4

Trends in LDCT examination volumes and percentage of stage 0 Lung Cancer from 2008 to 2021

Fig. 5

Trends in LDCT examination volumes and number of stage 0 Lung Cancer by gender from 2008 to 2021

Fig. 6

Exploring the changing distribution of lung cancer cases (stage 0 to stage 4) across different age groups in three distinct time periods (2009–2012, 2013–2016, 2017–2020)

Fig. 7

Changes in the number and percentage of stage 0 lung cancer in different age groups from 2008 to 2021

Fig. 8

Exploring the changing distribution of lung cancer cases (stage 0 to stage 4) across different age groups among men in three distinct time periods (2009–2012, 2013–2016, 2017–2020)

Fig. 9

Changes in the number and percentage of stage 0 lung cancer among men in different age groups from 2008 to 2021

Fig. 10

Exploring the changing distribution of lung cancer cases (stage 0 to stage 4) across different age groups among women in three distinct time periods (2009–2012, 2013–2016, 2017–2020)

Fig. 11

Changes in the number and percentage of stage 0 lung cancer among women in different age groups from 2008 to 2021