Do we know enough about the effect of low-dose computed tomography screening for lung cancer on survival to act? A systematic review, meta-analysis and network meta-analysis of randomised controlled trials

Abstract

BackgroundDiagnosis of lung cancer frequently occurs in its later stages. Low-dose computed tomography (LDCT) could detect lung cancer early.MethodsOur objective was to estimate the effect of LDCT lung cancer screening on mortality in high-risk populations. A systematic review of randomised controlled trials (RCTs) comparing LDCT screening programmes with usual care (no screening) or other imaging screening programme (such as chest X-ray (CXR)) was conducted. RCTs of CXR screening were additionally included in the network meta-analysis. Bibliographic sources including MEDLINE, Embase, Web of Science and the Cochrane Library were searched to January 2017. All key review steps were done by two persons. Quality assessment used the Cochrane Risk of Bias tool. Meta-analyses were performed.ResultsFour RCTs were included. More will provide data in the future. Meta-analysis demonstrated that LDCT screening with up to 9.80 years of follow-up was associated with a statistically non-significant decrease in lung cancer mortality (pooled relative risk (RR) 0.94, 95% confidence interval (CI) 0.74 to 1.19; p = 0.62). There was a statistically non-significant increase in all-cause mortality. Given the considerable heterogeneity for both outcomes, the results should be treated with caution.Network meta-analysis including the four original RCTs plus two further RCTs assessed the relative effectiveness of LDCT, CXR and usual care. The results showed that in terms of lung cancer mortality reduction LDCT was ranked as the best screening strategy, CXR screening as the worst strategy and usual care intermediate.ConclusionsLDCT screening may be effective in reducing lung cancer mortality but there is considerable uncertainty: the largest of the RCTs compared LDCT with CXR screening rather than no screening; there is imprecision of the estimates; and there is important heterogeneity between the included study results. The uncertainty about the effect on all-cause mortality is even greater. Maturing trials may resolve the uncertainty.

Do we know enough about the effect of low-dose computed tomography screening for lung cancer on mortality to act? An updated systematic review, meta-analysis and network meta-analysis of randomised controlled trials 2017 to 2021

“…Considering strengths and weaknesses, the research we report was undertaken by an experienced health technology assessment group, working to a pre-specified protocol, adhering to well-recognised standards for conducting systematic reviews. Further the research was an update, using the same method, as a highly scrutinised and multiply peer reviewed systematic review [ 12 , 13 ]. No members of the research team had any connection with the trialists for the included RCTs.…”

“…In 2018, our research group reported a systematic review and network meta-analysis of RCTs of LDCT screening for lung cancer with particular focus on the effect on disease-specific and all-cause mortality, searching up to 2017 [ 12 , 13 ]. We identified 12 eligible RCTs of which four contributed data to the direct meta-analyses of LDCT vs CXR or usual care, the remainder being on-going studies.…”

Coprevalence and Incidence of Lung Cancer in Patients Screened for Abdominal Aortic Aneurysm

“…This leads to the assumption that these patients do not reach the age to evolve their comorbidities but die of cancer before. Recent data indicate that the 5-year survival rate in patients with LC is still very poor, despite improvements in therapy and prevention strategies (30% for localized tumours and 5% for distant disease) (28). In 2019, lung cancer was the leading cause of death from cancer in men and women, accounting for more than 142.000 deaths in the United States, which is approximately 25% of all cancer deaths (7).…”

Psychological Impact of Ambiguous Health Messages about COVID-19

“…In medical contexts, scientists and experts often do not have all the answers or definitive information about the best course of action. This is particularly true with novel or unprecedented health treatments, diseases, or devices, such as electronic cigarettes (Katz et al, 2017 , 2018 ; Pepper et al, 2019 ; Simonovic & Taber, 2020 ) or lung cancer screening (i.e., low-dose computed tomography; Schapira et al, 2016 ; Yang et al, 2019 ). SARS-CoV-2 (more colloquially referred to as COVID-19 or the novel coronavirus) is a global pandemic that emerged in the United States in January 2020 about which very little scientific information was known with certainty at the start of the pandemic (CDC, 2020 ).…”