Annual CT lung screening was associated with a significant reduction in lung cancer-related mortality among individuals with a history of smoking, according to research published in the Journal of Clinical Oncology.
Researchers conducted a meta-analysis to determine the benefits and harms associated with CT lung screening. The analysis included 9 randomized, controlled trials comparing CT lung screening with either no screening or chest x-ray. The 88,497 patients included had a cigarette smoking history of at least 15 pack-years, and this included former smokers.
When compared with no screening or chest x-ray, CT screening was associated with a significant reduction in lung cancer-related mortality (risk ratio [RR], 0.87; 95% CI, 0.78-0.98; P =.02; 8 eight studies; 87,876 participants).
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When compared with the no-screening group alone, CT screening was associated with a significant reduction in lung cancer-related mortality (RR, 0.80; 95% CI, 0.69-0.92; P =.002; 6 studies; 31,106 participants).
However, there were no significant differences in lung cancer-related mortality between the CT screening and chest x-ray groups (RR, 0.95; 95% CI, 0.82-1.10; P =.48; 2 studies; 56,770 participants).
CT screening was associated with a significant increase in early-stage tumor diagnosis (RR, 2.42; 95% CI, 1.71-3.44; P <.00001). The increase was greater for CT screening compared with no screening (RR, 2.73; 95% CI, 1.91-3.90; P <.00001) than for CT screening compared with chest x-ray (RR, 1.52; 95% CI, 1.04-2.23; P =.03).
CT screening was associated with a significant decrease in the diagnosis of late-stage tumors (RR, 0.75; 95% CI, 0.68-0.83; P <.00001). The decrease was greater when CT screening was compared with no screening (RR, 0.67; 95% CI, 0.56-0.80; P <.0001), but there were no significant differences when CT screening was compared with chest x-ray (RR, 1.21; 95% CI, 0.38-3.89; P =.75).
There was a significant increase in overdiagnosis with CT screening overall (30%; 95% CI, 6-55; P =.02) and in the comparison between the CT screening and no-screening groups (38%; 95% CI, 14-63; P =.002). However, there was no significant difference between the CT screening group and the chest x-ray group (4%; 95% CI, -10 to 18; P =.57).
There was a significant increase in the resectability rate with CT screening compared with no screening (RR, 2.57; 95% CI, 1.76-3.74; P <.00001).
There was no significant reduction in all-cause mortality with CT screening (RR, 0.99; 95% CI, 0.94-1.05; P =.78). The findings were similar for the no-screening (RR, 0.98; 95% CI, 0.90-1.07; P =.69) and chest x-ray (RR, 1.04; 95% CI, 0.87-1.26; P =.64) comparisons.
“This meta-analysis provides an updated and reliable estimation of both desirable and undesirable effects related to CT [lung screening] in subjects with cigarette smoking history, which may serve as scientific support to the definition of evidence-based guidelines and shared decision-making worldwide,” the study authors wrote.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Passiglia F, Cinquini M, Bertolaccini L, et al. Benefits and harms of lung cancer screening by chest computed tomography: a systematic review and meta-analysis. J Clin Oncol. Published online June 2, 2021. doi:10.1200/JCO.20.02574
