A meta-analysis: is low-dose computed tomography a superior method for risky lung cancers screening population?

2014 ◽  
Vol 10 (3) ◽  
pp. 333-341 ◽  
Author(s):  
Cuiping Fu ◽  
Zilong Liu ◽  
Fen Zhu ◽  
Shanqun Li ◽  
Liyan Jiang
Keyword(s):  
Computed Tomography ◽  
Low Dose ◽  
Meta Analysis ◽  
Lung Cancers ◽  
Screening Population ◽  
Low Dose Computed Tomography

scholarly journals Effectiveness of Lung Cancer Screening Implementation in the Community Setting in the United States

2019 ◽  
Vol 15 (7) ◽  
pp. e607-e615 ◽  
Author(s):  
Amy Copeland ◽  
Angela Criswell ◽  
Andrew Ciupek ◽  
Jennifer C. King
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Cancer Screening ◽  
Low Dose ◽  
Community Setting ◽  
Lung Cancer Screening ◽  
The United States ◽  
Community Based ◽  
Lung Cancers ◽  
Low Dose Computed Tomography

PURPOSE: The National Lung Screening Trial demonstrated a 20% relative reduction in lung cancer mortality with low-dose computed tomography screening, leading to implementation of lung cancer screening across the United States. The Centers for Medicare and Medicaid Services approved coverage, but questions remained about effectiveness of community-based screening. To assess screening implementation during the first full year of CMS coverage, we surveyed a nationwide network of lung cancer screening centers, comparing results from academic and nonacademic centers. METHODS: One hundred sixty-five lung cancer screening centers that have been designated Screening Centers of Excellence responded to a survey about their 2016 program data and practices. The survey included 21 pretested, closed- and open-ended quantitative and qualitative questions covering implementation, workflow, numbers of screening tests completed, and cancers diagnosed. RESULTS: Centers were predominantly community based (62%), with broad geographic distribution. In both community and academic centers, more than half of lung cancers were diagnosed at stage I or limited stage, demonstrating a clear stage shift compared with historical data. Lung-RADS results were also comparable. There are wide variations in the ways centers address Centers for Medicare and Medicaid Services requirements. The most significant barriers to screening implementation were insurance and billing issues, lack of provider referral, lack of patient awareness, and internal workflow challenges. CONCLUSION: These data validate that responsible screening can take place in a community setting and that lung cancers detected by low-dose computed tomography screening are often diagnosed at an early, more treatable stage. Lung cancer screening programs have developed different ways to address requirements, but many implementation challenges remain.

scholarly journals Impact on All-Cause and Cardiovascular Mortality Rates of Coronary Artery Calcifications Detected during Organized, Low-Dose, Computed-Tomography Screening for Lung Cancer: Systematic Literature Review and Meta-Analysis

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1553
Author(s):  
Sébastien Gendarme ◽  
Helene Goussault ◽  
Jean-Baptiste Assié ◽  
Cherifa Taleb ◽  
Christos Chouaïd ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Coronary Artery ◽  
Cancer Screening ◽  
Low Dose ◽  
Meta Analysis ◽  
Lung Cancer Screening ◽  
Mortality Rates ◽  
All Cause Mortality ◽  
Low Dose Computed Tomography

Although organized, low-dose, computed-tomography (CT) scan lung-cancer screening has been shown to lower all-cause and lung-cancer-specific mortality, the primary cause of death for subjects eligible for such screening remains cardiovascular (CV) mortality. This meta-analysis study was undertaken to evaluate the impact of screening-scan-detected coronary artery calcifications (CACs) on CV and all-cause mortality. We conducted a systematic review and meta-analysis of studies reporting CV mortality according to the Agatson CAC score for participants in a lung-cancer screening program of randomized clinical or cohort studies. PubMed, Embase, and Cochrane databases were screened in June 2020. Two authors independently selected articles and extracted data. Six studies, including 20,175 subjects, were retained. CV and all-cause mortality rates were higher for subjects with CAC scores >0, with respective relative risks of 2.02 [95% CI 1.23–3.32] and 2.29 [95% CI 1.00–5.21]. Both mortality rates were even higher for those with high CAC scores (>400 or >1000). CACs are more common in men than in women, with an odds ratio of 1.49 [95% CI 1.40–1.59]. The presence of CAC is associated with CV mortality with an RR of 2.05 [95% CI 1.20–3.57] in men and 2.37 [CI 95% 1.29–5.09] in women, respectively. Analysis of lung-cancer-screening scans for CACs is a tool able to predict CV mortality. Prospective studies within those programs are needed to assess the benefit of primary CV prevention based on CAC detection.

scholarly journals Organ doses and associated cancer risks for computed tomography examinations of the thoracic region

2018 ◽  
Vol 33 (1) ◽  
pp. 100-105 ◽  
Author(s):  
Marija Majer ◽  
Zeljka Knezevic ◽  
Jelena Popic ◽  
Hrvoje Hrsak ◽  
Saveta Miljanic
Keyword(s):  
Computed Tomography ◽  
Low Dose ◽  
Attributable Risk ◽  
Breast Cancers ◽  
Organ Doses ◽  
Lung Cancers ◽  
Lifetime Attributable Risk ◽  
Radiation Induced Cancer ◽  
Average Factor ◽  
Low Dose Computed Tomography

The use of computed tomography is increasing rapidly and doses are not negligible especially when medical procedures require more than one scan. The purpose of the present study was to measure doses in an anthropomorphic Rando phantom during a standard and low dose computed tomography protocol of the thorax and to estimate risks of radiation induced cancer for adult patients that undergo multiple computed tomography scans of the thorax. Thermoluminescent and radiophotoluminescent dosimeters were used for dose measurements. Radiation risks of cancer incidence, in the form of lifetime attributable risk, were estimated using the BEIR VII model. For five exposures with the standard protocol mean organ doses were 94 mGy (breast), 85 mGy (stomach), 85 mGy (thyroid), 78 mGy (lung), 52 mGy (liver), and 16 mGy (colon). Associated lifetime attributable risk were found to be up to 0.401 % (401 breast cancers per 100 000 exposed patients) and 0.116 % (116 lung cancers per 100 000 exposed patients) for female and male, respectively. A low dose protocol reduces doses (and risks) by the average factor of 5 and therefore the use of a low dose protocol is recommended whenever it is medicaly justified.

Systematic review and meta-analysis on the impact of lung cancer screening by low-dose computed tomography

2020 ◽  
Vol 134 ◽  
pp. 107-114 ◽  
Author(s):  
Alexandre Sadate ◽  
Bob V. Occean ◽  
Jean-Paul Beregi ◽  
Aymeric Hamard ◽  
Takieddine Addala ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Systematic Review ◽  
Cancer Screening ◽  
Low Dose ◽  
Meta Analysis ◽  
Lung Cancer Screening ◽  
Low Dose Computed Tomography ◽  
The Impact

scholarly journals Overdiagnosis of lung cancer with low-dose computed tomography screening: meta-analysis of the randomised clinical trials

Breathe ◽  
2020 ◽  
Vol 16 (1) ◽  
pp. 200013 ◽  
Author(s):  
John Brodersen ◽  
Theis Voss ◽  
Frederik Martiny ◽  
Volkert Siersma ◽  
Alexandra Barratt ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Cancer Screening ◽  
Randomised Controlled Trials ◽  
Low Dose ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Low Risk ◽  
Randomised Controlled ◽  
Low Dose Computed Tomography

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.Key pointsNine randomised controlled trials (RCTs) on low-dose computed tomography screening were identified; five were included for meta-analysis but only two of those were at low risk of bias.In a meta-analysis of recent low risk of bias RCTs including 8156 healthy current or former smokers from developed countries, we found that 49% of the screen-detected cancers may be overdiagnosed.There is uncertainty about the degree of overdiagnosis in lung cancer screening due to unexplained heterogeneity and low precision of the point estimate.If only high-quality RCTs are included in the meta-analysis, the degree of overdiagnosis is substantial.Educational aimsTo appreciate that low-dose computed tomography screening for lung cancer meets all three main conditions for overdiagnosis in cancer screening: a reservoir of indolent cancers exists in the population; the screening test is able to “tap” this reservoir by detecting biologically indolent cancers as well as biologically important cancers; and the population being screened is characterised by a relatively high competing risk of death from other causesTo learn about biases that might affect the estimates of overdiagnosis in randomised controlled trials in cancer screening

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