Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening Scenarios
Lung cancer is a severe disease that affects predominantly smokers and represents a leading cause of cancer death in Europe. Recent meta-analyses of randomized controlled trials (RCTs) have yielded that low-dose computed tomography (LDCT) screening can significantly reduce lung cancer mortality in h...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-02-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/12/2/364 |
| _version_ | 1797481240473894912 |
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| author | Elke A. Nekolla Gunnar Brix Jürgen Griebel |
| author_facet | Elke A. Nekolla Gunnar Brix Jürgen Griebel |
| author_sort | Elke A. Nekolla |
| collection | DOAJ |
| description | Lung cancer is a severe disease that affects predominantly smokers and represents a leading cause of cancer death in Europe. Recent meta-analyses of randomized controlled trials (RCTs) have yielded that low-dose computed tomography (LDCT) screening can significantly reduce lung cancer mortality in heavy smokers or ex-smokers by about 20% compared to a control group of persons who did not receive LDCT. This benefit must be weighed against adverse health effects associated with LDCT lung screening, in particular radiation risks. For this purpose, representative organ doses were determined for a volume CT dose index of 1 mGy that can be achieved on modern devices. Using these values, radiation risks were estimated for different screening scenarios by means of sex-, organ-, and age-dependent radio-epidemiologic models. In particular, the approach was adjusted to a Western European population. For an annual LDCT screening of (ex-)smokers aged between 50 and 75 years, the estimated radiation-related lifetime attributable risk to develop cancer is below 0.25% for women and about 0.1% for men. Assuming a mortality reduction of about 20% and taking only radiation risks into account, this screening scenario results in a benefit–risk ratio of about 10 for women and about 25 for men. These benefit–risk ratio estimates are based on the results of RCTs of the highest evidence level. To ensure that the benefit outweighs the radiation risk even in standard healthcare, strict conditions and requirements must be established for the entire screening process to achieve a quality level at least as high as that of the considered RCTs. |
| first_indexed | 2024-03-09T22:11:40Z |
| format | Article |
| id | doaj.art-bf3b05be765940efb3fd801b936d6f01 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-09T22:11:40Z |
| publishDate | 2022-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-bf3b05be765940efb3fd801b936d6f012023-11-23T19:30:49ZengMDPI AGDiagnostics2075-44182022-02-0112236410.3390/diagnostics12020364Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening ScenariosElke A. Nekolla0Gunnar Brix1Jürgen Griebel2Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Ingolstaedter Landstrasse 1, 85764 Oberschleissheim, GermanyDepartment of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Ingolstaedter Landstrasse 1, 85764 Oberschleissheim, GermanyDepartment of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Ingolstaedter Landstrasse 1, 85764 Oberschleissheim, GermanyLung cancer is a severe disease that affects predominantly smokers and represents a leading cause of cancer death in Europe. Recent meta-analyses of randomized controlled trials (RCTs) have yielded that low-dose computed tomography (LDCT) screening can significantly reduce lung cancer mortality in heavy smokers or ex-smokers by about 20% compared to a control group of persons who did not receive LDCT. This benefit must be weighed against adverse health effects associated with LDCT lung screening, in particular radiation risks. For this purpose, representative organ doses were determined for a volume CT dose index of 1 mGy that can be achieved on modern devices. Using these values, radiation risks were estimated for different screening scenarios by means of sex-, organ-, and age-dependent radio-epidemiologic models. In particular, the approach was adjusted to a Western European population. For an annual LDCT screening of (ex-)smokers aged between 50 and 75 years, the estimated radiation-related lifetime attributable risk to develop cancer is below 0.25% for women and about 0.1% for men. Assuming a mortality reduction of about 20% and taking only radiation risks into account, this screening scenario results in a benefit–risk ratio of about 10 for women and about 25 for men. These benefit–risk ratio estimates are based on the results of RCTs of the highest evidence level. To ensure that the benefit outweighs the radiation risk even in standard healthcare, strict conditions and requirements must be established for the entire screening process to achieve a quality level at least as high as that of the considered RCTs.https://www.mdpi.com/2075-4418/12/2/364lung cancer screeninglow-dose CTradiation risksradio-epidemiological modelsbenefit–risk ratios |
| spellingShingle | Elke A. Nekolla Gunnar Brix Jürgen Griebel Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening Scenarios Diagnostics lung cancer screening low-dose CT radiation risks radio-epidemiological models benefit–risk ratios |
| title | Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening Scenarios |
| title_full | Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening Scenarios |
| title_fullStr | Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening Scenarios |
| title_full_unstemmed | Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening Scenarios |
| title_short | Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening Scenarios |
| title_sort | lung cancer screening with low dose ct radiation risk and benefit risk assessment for different screening scenarios |
| topic | lung cancer screening low-dose CT radiation risks radio-epidemiological models benefit–risk ratios |
| url | https://www.mdpi.com/2075-4418/12/2/364 |
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