Do we know enough about the effect of low-dose computed tomography screening for lung cancer on mortality to act? An updated systematic review, meta-analysis and network meta-analysis of randomised controlled trials 2017 to 2021
Abstract Background For people at high risk of lung cancer, low-dose computed tomography (LDCT) is proposed as a method to reduce mortality. Methods Our objective was to estimate the effect of LDCT lung cancer screening on mortality in high-risk populations. A systematic review of randomised control...
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | Diagnostic and Prognostic Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41512-023-00162-0 |
| _version_ | 1797387975337705472 |
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| author | Emma Duer Huiqin Yang Sophie Robinson Bogdan Grigore Josie Sandercock Tristan Snowsill Ed Griffin Jaime Peters Chris Hyde |
| author_facet | Emma Duer Huiqin Yang Sophie Robinson Bogdan Grigore Josie Sandercock Tristan Snowsill Ed Griffin Jaime Peters Chris Hyde |
| author_sort | Emma Duer |
| collection | DOAJ |
| description | Abstract Background For people at high risk of lung cancer, low-dose computed tomography (LDCT) is proposed as a method to reduce mortality. Methods Our objective was to estimate the effect of LDCT lung cancer screening on mortality in high-risk populations. A systematic review of randomised controlled trials (RCTs) comparing LDCT screening programmes with usual care (no screening) or other imaging screening programme (such as chest X-ray (CXR)) was conducted. RCTs of CXR screening were additionally included in the network meta-analyses. Bibliographic sources including MEDLINE, Embase, Web of Science and the Cochrane Library were searched to January 2017, and then further extended to November 2021. All key review steps were done by two persons. Quality assessment used the Cochrane Risk of Bias tool. Meta-analyses were performed. Results Nine RCTs, with up to 12.3 years of follow-up from randomisation, were included in the direct meta-analysis, which showed that LDCT screening was associated with a statistically significant decrease in lung cancer mortality (pooled relative risk (RR) 0.86, 95% confidence interval [CI] 0.77 to 0.96). There was a statistically non-significant decrease in all-cause mortality (pooled RR 0.98, 95% CI 0.95 to 1.01). The statistical heterogeneity for both outcomes was minimal. Network meta-analysis including the nine RCTs in the direct meta-analysis plus two further RCTs comparing CXR with usual care confirmed the size of the effect of LDCT on lung cancer mortality and that this was very similar irrespective of whether the comparator was usual care or CXR screening. Conclusions LDCT screening is effective in reducing lung cancer mortality in high-risk populations. The uncertainty of its effect on lung cancer mortality observed in 2018 has been much reduced with new trial results and updates to existing trials, emphasising the importance of updating systematic reviews. Although there are still a number of RCTs unreported or in progress, we predict that further evolution of summary mortality estimates is unlikely. The focus for debate now moves to resolving uncertainty about the cost-effectiveness of LDCT screening taking into account the balance between benefits and harms which occur in all screening programmes. |
| first_indexed | 2024-03-08T22:34:00Z |
| format | Article |
| id | doaj.art-0dab3bd5d377467c99299a4c2261a592 |
| institution | Directory Open Access Journal |
| issn | 2397-7523 |
| language | English |
| last_indexed | 2024-03-08T22:34:00Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
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| series | Diagnostic and Prognostic Research |
| spelling | doaj.art-0dab3bd5d377467c99299a4c2261a5922023-12-17T12:33:23ZengBMCDiagnostic and Prognostic Research2397-75232023-12-017111410.1186/s41512-023-00162-0Do we know enough about the effect of low-dose computed tomography screening for lung cancer on mortality to act? An updated systematic review, meta-analysis and network meta-analysis of randomised controlled trials 2017 to 2021Emma Duer0Huiqin Yang1Sophie Robinson2Bogdan Grigore3Josie Sandercock4Tristan Snowsill5Ed Griffin6Jaime Peters7Chris Hyde8Queen Mary University of London, Barts and The London School of Medicine and DentistrySchool of Healthcare, Faculty of Medicine & Health, University of LeedsEvidence Synthesis & Modelling for Health Improvement, University of Exeter Medical SchoolExeter Test Group, University of Exeter Medical SchoolSystematic Review Initiative, NHS Blood & TransplantHealth Economics Group, University of Exeter Medical SchoolExeter Test Group, University of Exeter Medical SchoolExeter Test Group, University of Exeter Medical SchoolExeter Test Group, University of Exeter Medical SchoolAbstract Background For people at high risk of lung cancer, low-dose computed tomography (LDCT) is proposed as a method to reduce mortality. Methods Our objective was to estimate the effect of LDCT lung cancer screening on mortality in high-risk populations. A systematic review of randomised controlled trials (RCTs) comparing LDCT screening programmes with usual care (no screening) or other imaging screening programme (such as chest X-ray (CXR)) was conducted. RCTs of CXR screening were additionally included in the network meta-analyses. Bibliographic sources including MEDLINE, Embase, Web of Science and the Cochrane Library were searched to January 2017, and then further extended to November 2021. All key review steps were done by two persons. Quality assessment used the Cochrane Risk of Bias tool. Meta-analyses were performed. Results Nine RCTs, with up to 12.3 years of follow-up from randomisation, were included in the direct meta-analysis, which showed that LDCT screening was associated with a statistically significant decrease in lung cancer mortality (pooled relative risk (RR) 0.86, 95% confidence interval [CI] 0.77 to 0.96). There was a statistically non-significant decrease in all-cause mortality (pooled RR 0.98, 95% CI 0.95 to 1.01). The statistical heterogeneity for both outcomes was minimal. Network meta-analysis including the nine RCTs in the direct meta-analysis plus two further RCTs comparing CXR with usual care confirmed the size of the effect of LDCT on lung cancer mortality and that this was very similar irrespective of whether the comparator was usual care or CXR screening. Conclusions LDCT screening is effective in reducing lung cancer mortality in high-risk populations. The uncertainty of its effect on lung cancer mortality observed in 2018 has been much reduced with new trial results and updates to existing trials, emphasising the importance of updating systematic reviews. Although there are still a number of RCTs unreported or in progress, we predict that further evolution of summary mortality estimates is unlikely. The focus for debate now moves to resolving uncertainty about the cost-effectiveness of LDCT screening taking into account the balance between benefits and harms which occur in all screening programmes.https://doi.org/10.1186/s41512-023-00162-0Lung neoplasmsMass screeningEarly detection of cancerTomographyX-ray computed tomographySpiral computed |
| spellingShingle | Emma Duer Huiqin Yang Sophie Robinson Bogdan Grigore Josie Sandercock Tristan Snowsill Ed Griffin Jaime Peters Chris Hyde Do we know enough about the effect of low-dose computed tomography screening for lung cancer on mortality to act? An updated systematic review, meta-analysis and network meta-analysis of randomised controlled trials 2017 to 2021 Diagnostic and Prognostic Research Lung neoplasms Mass screening Early detection of cancer Tomography X-ray computed tomography Spiral computed |
| title | Do we know enough about the effect of low-dose computed tomography screening for lung cancer on mortality to act? An updated systematic review, meta-analysis and network meta-analysis of randomised controlled trials 2017 to 2021 |
| title_full | Do we know enough about the effect of low-dose computed tomography screening for lung cancer on mortality to act? An updated systematic review, meta-analysis and network meta-analysis of randomised controlled trials 2017 to 2021 |
| title_fullStr | Do we know enough about the effect of low-dose computed tomography screening for lung cancer on mortality to act? An updated systematic review, meta-analysis and network meta-analysis of randomised controlled trials 2017 to 2021 |
| title_full_unstemmed | Do we know enough about the effect of low-dose computed tomography screening for lung cancer on mortality to act? An updated systematic review, meta-analysis and network meta-analysis of randomised controlled trials 2017 to 2021 |
| title_short | Do we know enough about the effect of low-dose computed tomography screening for lung cancer on mortality to act? An updated systematic review, meta-analysis and network meta-analysis of randomised controlled trials 2017 to 2021 |
| title_sort | do we know enough about the effect of low dose computed tomography screening for lung cancer on mortality to act an updated systematic review meta analysis and network meta analysis of randomised controlled trials 2017 to 2021 |
| topic | Lung neoplasms Mass screening Early detection of cancer Tomography X-ray computed tomography Spiral computed |
| url | https://doi.org/10.1186/s41512-023-00162-0 |
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