Overdiagnosis of lung cancer with low-dose computed tomography screening: meta-analysis of the randomised clinical trials
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Overdiagnosis of lung cancer with low-dose computed tomography screening : meta-analysis of the randomised clinical trials. / Brodersen, John; Voss, Theis; Martiny, Frederik; Siersma, Volkert; Barratt, Alexandra; Heleno, Bruno.
In: Breathe, Vol. 16, No. 1, 200013, 2020.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - Overdiagnosis of lung cancer with low-dose computed tomography screening
T2 - meta-analysis of the randomised clinical trials
AU - Brodersen, John
AU - Voss, Theis
AU - Martiny, Frederik
AU - Siersma, Volkert
AU - Barratt, Alexandra
AU - Heleno, Bruno
PY - 2020
Y1 - 2020
N2 - In low-dose computed tomography (LDCT) screening for lung cancer, all three main conditions for overdiagnosis in cancer screening are present: 1) a reservoir of slowly or nongrowing lung cancer exists; 2) LDCT is a high-resolution imaging technology with the potential to identify this reservoir; and 3) eligible screening participants have a high risk of dying from causes other than lung cancer. The degree of overdiagnosis in cancer screening is most validly estimated in high-quality randomised controlled trials (RCTs), with enough follow-up time after the end of screening to avoid lead-time bias and without contamination of the control group.Nine RCTs investigating LDCT screening were identified. Two RCTs were excluded because lung cancer incidence after the end of screening was not published. Two other RCTs using active comparators were also excluded. Therefore, five RCTs were included: two trials were at low risk of bias, two of some concern and one at high risk of bias. In a meta-analysis of the two low risk of bias RCTs including 8156 healthy current or former smokers, 49% of the screen-detected cancers were overdiagnosed. There is uncertainty about this substantial degree of overdiagnosis due to unexplained heterogeneity and low precision of the summed estimate across the two trials.
AB - In low-dose computed tomography (LDCT) screening for lung cancer, all three main conditions for overdiagnosis in cancer screening are present: 1) a reservoir of slowly or nongrowing lung cancer exists; 2) LDCT is a high-resolution imaging technology with the potential to identify this reservoir; and 3) eligible screening participants have a high risk of dying from causes other than lung cancer. The degree of overdiagnosis in cancer screening is most validly estimated in high-quality randomised controlled trials (RCTs), with enough follow-up time after the end of screening to avoid lead-time bias and without contamination of the control group.Nine RCTs investigating LDCT screening were identified. Two RCTs were excluded because lung cancer incidence after the end of screening was not published. Two other RCTs using active comparators were also excluded. Therefore, five RCTs were included: two trials were at low risk of bias, two of some concern and one at high risk of bias. In a meta-analysis of the two low risk of bias RCTs including 8156 healthy current or former smokers, 49% of the screen-detected cancers were overdiagnosed. There is uncertainty about this substantial degree of overdiagnosis due to unexplained heterogeneity and low precision of the summed estimate across the two trials.
KW - CT
KW - HARMS
KW - MORTALITY
KW - BENEFITS
KW - GROWTH
KW - IMPLEMENTATION
KW - DESIGN
U2 - 10.1183/20734735.0013-2020
DO - 10.1183/20734735.0013-2020
M3 - Review
C2 - 32194774
VL - 16
JO - Breathe
JF - Breathe
SN - 1810-6838
IS - 1
M1 - 200013
ER -
ID: 245319046