Overdiagnosis in Low-Dose Computed Tomography Screening for Lung Cancer

Patz, Edward F.; Pinsky, Paul F.; Gatsonis, Constantine; Sicks, Jo Rean D.; Kramer, Barnett S.; Tammemägi, Martin C.; Chiles, Caroline; Black, William C.; Aberle, Denise R.

doi:10.1001/jamainternmed.2013.12738

Cited by 667 publications

(559 citation statements)

References 21 publications

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“…Consistent with this, those cancers most likely to be overdiagnosed are prostate cancer, from prostate-specific antigen testing of asymptomatic men in primary care; breast cancer, from organised mammography screening; thyroid cancer, from ultrasound of the thyroid and/or adjoining structures; and lung cancer, from screening smokers using computed tomography. 7,10,13,[19][20][21] Discussing overdiagnosis is good science, not an accusation of malpractice It is the nature of science to change: a scientific attitude entails scepticism and openness to questioning. Overdiagnosis in cancer screening has become topical because, within the science of cancer, it has become increasingly clear that some cancers do not need to be found, and that the benefit/harm balance of screening is less favourable than originally hoped.…”

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confidence: 99%

What is overdiagnosis and why should we take it seriously in cancer screening?

Carter¹,

Barratt²

2017

Public Health Res Pract

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Overdiagnosis occurs in a population when conditions are diagnosed correctly but the diagnosis produces an unfavourable balance between benefits and harms. In cancer screening, overdiagnosed cancers are those that did not need to be found because they would not have produced symptoms or led to premature death. These overdiagnosed cancers can be distinguished from false positives, which occur when an initial screening test suggests that a person is at high risk but follow-up testing shows them to be at normal risk. The cancers most likely to be overdiagnosed through screening are those of the prostate, thyroid, breast and lung. Overdiagnosis in cancer screening arises largely from the paradoxical problem that screening is most likely to find the slow-growing or dormant cancers that are least likely to harm us, and less likely to find the aggressive, fast-growing cancers that cause cancer mortality. This central paradox has become clearer over recent decades. The more overdiagnosis is produced by a screening program, the less likely the program is to serve its ultimate goal of reducing illness and premature death from cancer. Thus, it is vital that health professionals and researchers continue an open, scientific inquiry into the extent and consequences of overdiagnosis, and devise appropriate responses to it.

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confidence: 99%

What is overdiagnosis and why should we take it seriously in cancer screening?

Carter¹,

Barratt²

2017

Public Health Res Pract

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“…A further potential harm, not yet accounted for in the above calculation, is overdiagnosis. A recent analysis of the NLST data indicates that more than 18% of all lung cancers detected by LDCT may be indolent, and that for one life saved (i.e., out of 320 individuals screened), the expected number of cases of overdiagnosis is 1.38 (33).…”

Section: Discussionmentioning

confidence: 99%

Selecting High-Risk Individuals for Lung Cancer Screening: A Prospective Evaluation of Existing Risk Models and Eligibility Criteria in the German EPIC Cohort

Hüsing

Sookthai

et al. 2015

Cancer Prevention Research

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Lung cancer risk prediction models are considered more accurate than the eligibility criteria based on age and smoking in identification of high-risk individuals for screening. We externally validated four lung cancer risk prediction models (Bach, Spitz, LLP, and PLCO M2012 ) among 20,700 ever smokers in the EPIC-Germany cohort. High-risk subjects were identified using the eligibility criteria applied in clinical trials (NELSON/ LUSI, DLCST, ITALUNG, DANTE, and NLST) and the four risk prediction models. Sensitivity, specificity, and positive predictive value (PPV) were calculated based on the lung cancers diagnosed in the first 5 years of follow-up. Decision curve analysis was performed to compare net benefits. The number of high-risk subjects identified by the eligibility criteria ranged from 3,409 (NELSON/LUSI) to 1,458 (NLST). Among the eligibility criteria, the DLCST produced the highest sensitivity (64.13%), whereas the NLST produced the highest specificity (93.13%) and PPV (2.88%). The PLCO M2012 model showed the best performance in external validation (C-index: 0.81; 95% CI, 0.76-0.86; E/O: 1.03; 95% CI, 0.87-1.23) and the highest sensitivity, specificity, and PPV, but the superiority over the Bach model and the LLP model was modest. All the models but the Spitz model showed greater net benefit over the full range of risk estimates than the eligibility criteria. We concluded that all of the lung cancer risk prediction models apart from the Spitz model have a similar accuracy to identify high-risk individuals for screening, but in general outperform the eligibility criteria used in the screening trials. Cancer Prev Res; 8(9);

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“…[35] Chest X-ray would be taken in order to see if there are any masses in the lungs. [36] explains special techniques such as Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI) that provide more precise information about the possibility, size, shape and location of any tumours. A new radiology technique which combines the Positron Emission Tomography with CT (PET-CT) aids to provide more accurate details about tumour progression and to diagnose lung tumour better.…”

Section: Physical Examination and Initial Testsmentioning

confidence: 99%

Bronchogenic Carcinomas- A Review

Pande¹

2016

DJ IJMR

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Our body is a society of cells, which is made up of more than a hundred million of living cells. Changes in the appearance and functions of one cell or a small group of cells may result in a noninfectious or non-communicable disease called cancer. Cancer is referred to as an ailment characterised by an unrestrained growth of abnormal cells which if untreated and unchecked eventually kills the patient. Cancer cell growth is different from normal cell growth. It begins, when cells in certain part of the body starts to grow out of control. Instead of dying, the cells continue to grow and form new abnormal cells. Growing out of control and invading other tissues are what makes a cell as a cancer cell. Cells become cancer cells because of the damage to deoxyribonucleic acid. Several parts of the body may get affected by this disease called cancer. We all have a risk of developing cancer. So, it"s important to know and aware on exactly about what are cancer and their types, symptoms and also about its treatment. Oncology is termed as the study of cancer, where its main objectives are to determine its causes, find prevention methods, develop early detection methods and to find an effective treatment.

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Overdiagnosis in Low-Dose Computed Tomography Screening for Lung Cancer

Cited by 667 publications

References 21 publications

What is overdiagnosis and why should we take it seriously in cancer screening?

What is overdiagnosis and why should we take it seriously in cancer screening?

Selecting High-Risk Individuals for Lung Cancer Screening: A Prospective Evaluation of Existing Risk Models and Eligibility Criteria in the German EPIC Cohort

Bronchogenic Carcinomas- A Review

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