Although low-dose computed tomography (LDCT) screening may be beneficial for some individuals, there are concerns about the potential harms of screening, according to a review published online May 20 in the Journal of the American Medical Association to coincide with presentation at the annual meeting of the American Thoracic Society, held from May 18 to 23 in San Francisco.
Peter B. Bach, M.D., from the Memorial Sloan-Kettering Cancer Center in New York City, and colleagues conducted a systematic literature review regarding the benefits and harms of LDCT. Using a multisociety collaborative initiative, a foundation for the development of evidence-based clinical guidelines was developed.
Of the 591 citations identified, the researchers included eight randomized trials and 13 cohort studies, of which three randomized studies provided evidence on the effect of LDCT on lung cancer mortality. Among 53,454 participants enrolled in the National Lung Screening Trial, screening resulted in significantly fewer lung cancer deaths (relative risk, 0.80). Two smaller studies showed no benefit of lung cancer screening. In each round of screening, approximately 20 percent of individuals had positive results necessitating follow-up, but only 1 percent had lung cancer. The frequency of follow-up investigations, biopsies, and percentage of surgical procedures performed in patients with benign lesions varied widely. Major complications resulting from follow-up procedures in those with benign conditions were rare.
"Low-dose computed tomography screening may benefit individuals at an increased risk for lung cancer, but uncertainty exists about the potential harms of screening and the generalizability of results," the authors write.
Several authors disclosed financial ties to the pharmaceutical, medical device, and biotechnology industries.
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