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Sudarikov A. COVID-19 and Cancer Detection in Russia. Cancers (Basel) 2024; 16:1673. [PMID: 38730625 PMCID: PMC11083030 DOI: 10.3390/cancers16091673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Overdiagnosis, associated with mass testing in healthy populations, is a significant issue for breast, prostate, renal, and thyroid cancers. During the lockdowns caused by the COVID-19 pandemic, the intensity of cancer screening was expected to go down. In this study, we analyzed the impact of the expected reduction in screening intensity on morbidity and mortality from certain malignancies. Cumulative data from the Russian National Cancer Registry available from 2000 to 2022 were analyzed. It was noted that there has been no noticeable effect of the COVID-19 lockdowns on mortality rates from breast, prostate, renal, or thyroid cancers. At the same time, the detectable incidence decreased markedly in 2020 at the time of the lockdowns and then returned to pre-pandemic levels in 2022. At the moment, there is no sufficient reason to believe that skipping screening tests in 2020 could have any impact on breast, prostate, renal, or thyroid cancer mortality two years later (2022). The data presented further confirm that the overdiagnosis of these types of malignancies is caused by widespread screening among a generally healthy population.
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Affiliation(s)
- Andrey Sudarikov
- National Medical Research Center for Hematology, Novy Zykovski Lane, 4a, 125167 Moscow, Russia
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Chien LH, Jiang HF, Tsai FY, Chang HY, Freedman ND, Rothman N, Lan Q, Hsiung CA, Chang IS. Incidence of Lung Adenocarcinoma by Age, Sex, and Smoking Status in Taiwan. JAMA Netw Open 2023; 6:e2340704. [PMID: 37910104 PMCID: PMC10620613 DOI: 10.1001/jamanetworkopen.2023.40704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/19/2023] [Indexed: 11/03/2023] Open
Abstract
Importance Knowing whether the effects of smoking and other risk factors with lung adenocarcinoma (ADC) incidence varies by sex would provide information on lung cancer prevention strategies. Objective To evaluate whether women in Taiwan have higher age- and tumor stage-specific lung ADC incidence rates than men irrespective of smoking status (ie, ever smoker or never smoker). Design, Setting, and Participants This population-based cohort study used data sets synthesized from the Taiwan Cancer Registry (TCR) from 1979 to 2019; the TCR Long Form (TCRLF) from 2011 to 2019, which provides individual-level smoking and tumor stage information; the Taiwan Cause of Death Database (TCOD) from 1985 to 2019; the National Health Insurance Research Database (NHIRD) from 2000 to 2020; the Monthly Bulletin of Interior Statistics (MBIS) from 2011 to 2019; the National Health Interview Survey from 2001, 2005, 2009, 2013, and 2017; and Taiwan Biobank data from 2008 to 2021. Included patients were aged 40 to 84 years and had any invasive lung cancer from January 1, 2011, to December 31, 2019. Exposure Smoking status. Main Outcomes and Measures The main outcomes were age-specific female-to-male incidence rate ratios (IRRs) of lung ADC by smoking status and tumor stage. Linked data from the TCR, TCOD, NHIRD, Taiwan National Health Interview Survey, and MBIS were used to estimate the age- and sex-specific numbers of cancer-free individuals at midyears from 2011 to 2019 by smoking status. Using the TCR and TCRLF, age-, sex-, tumor stage-, and diagnosis year-specific numbers of patients with lung ADC from 2011 to 2019 by smoking status were estimated. Results A total of 61 285 patients (32 599 women [53.2%]) aged 40 to 84 years (mean [SD] age, 64.66 [10.79] years) in the Taiwanese population of approximately 23 million were diagnosed with invasive lung ADC as their first lifetime cancer between 2011 and 2019. Among smokers, men had higher tobacco use by almost all examined metrics, including nearly twice the mean (SD) number of pack-years smoked (eg, 7.87 [8.30] for men aged 30-34 years vs 4.38 [5.27] for women aged 30-34 years). For 5-year age bands between 40 and 84 years, incidence of lung ADC was significantly higher among females than males for nearly all age groups irrespective of tumor stage and smoking status (eg, for the age group 70-74 years, the female-to-male IRR for late-stage lung ADC among never smokers was 1.38 [95% CI, 1.30-1.50]). Conclusions and Relevance In this cohort study, women had higher age- and stage-specific lung ADC incidence rates than men in Taiwan for both never and ever smokers, suggesting the possibility of differential exposures between sexes to risk factors other than smoking and the potential modification of ADC risk factors by sex. Further work is needed to determine whether this pattern replicates in other populations, discover the causes of lung ADC, and put preventive measures in place.
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Affiliation(s)
- Li-Hsin Chien
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- Department of Applied Mathematics, Chung-Yuan Christian University, Chung-Li, Taiwan
| | - Hsin-Fang Jiang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Fang-Yu Tsai
- National Institute of Cancer Research, National Health Research Institutes, Zhunan, Taiwan
| | - Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Chao A. Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - I-Shou Chang
- National Institute of Cancer Research, National Health Research Institutes, Zhunan, Taiwan
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Why Are Women More Likely to Be Overdiagnosed With Lung Cancer? Chest 2023; 163:22-24. [PMID: 36628669 DOI: 10.1016/j.chest.2022.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/10/2022] [Indexed: 01/10/2023] Open
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Rich NE, Singal AG. Overdiagnosis of hepatocellular carcinoma: Prevented by guidelines? Hepatology 2022; 75:740-753. [PMID: 34923659 PMCID: PMC8844206 DOI: 10.1002/hep.32284] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/27/2021] [Accepted: 12/04/2021] [Indexed: 12/13/2022]
Abstract
Overdiagnosis refers to detection of disease that would not otherwise become clinically apparent during a patient's lifetime. Overdiagnosis is common and has been reported for several cancer types, although there are few studies describing its prevalence in HCC surveillance programs. Overdiagnosis can have serious negative consequences including overtreatment and associated complications, financial toxicity, and psychological harms related to being labeled with a cancer diagnosis. Overdiagnosis can occur for several different reasons including inaccurate diagnostic criteria, detection of premalignant or very early malignant lesions, detection of indolent tumors, and competing risks of mortality. The risk of overdiagnosis is partly mitigated, albeit not eliminated, by several guideline recommendations, including definitions for the at-risk population in whom surveillance should be performed, surveillance modalities, surveillance interval, recall procedures, and HCC diagnostic criteria. Continued research is needed to further characterize the burden and trends of overdiagnosis as well as identify strategies to reduce overdiagnosis in the future.
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Affiliation(s)
- Nicole E Rich
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Amit G Singal
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
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Jatoi I, Anderson WF, Miller AB, Brawley OW. The history of cancer screening. Curr Probl Surg 2019; 56:138-163. [PMID: 30922446 DOI: 10.1067/j.cpsurg.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Ismail Jatoi
- Division of Surgical Oncology, Dale H. Dorn Endowed Chair in Surgery, University of Texas Health Science Center, San Antonio, TX.
| | - William F Anderson
- National Institutes of Health/National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MA
| | - Anthony B Miller
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Otis W Brawley
- Michael Bloomberg Distinguished Professor of Oncology and Public Health, Johns Hopkins University, Baltimore, MA
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National Lung Cancer Screening Trial American College of Radiology Imaging Network Specimen Biorepository originating from the Contemporary Screening for the Detection of Lung Cancer Trial (NLST, ACRIN 6654): design, intent, and availability of specimens for validation of lung cancer biomarkers. J Thorac Oncol 2011; 5:1502-6. [PMID: 20871260 DOI: 10.1097/jto.0b013e3181f1c634] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
The present paradigm is that slow-growing and clinically unimportant lung cancers are very rare. Over the years, convincing evidence for their existence in significant numbers has been dismissed, but with computerized tomography scanning being increasingly common, their reality can no longer be denied. The time is now ripe for a paradigm shift--with consequences for screening as well as clinical practice in the future. The doubling time of the tumor is probably the most important factor for survival of the patient, and research on how to measure this figure is urgent. Age, smoking habits, and comorbidities of the patient are now the main factors when discussing treatment with the patient; once we can predict the behavior of the cancer, i.e., whether it is indolent or actually threatens the patient's life, we will be able to give better advice.
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Abstract
Lung cancer is the leading cause of cancer death in the United States. Non-small cell lung cancer accounts for 75% to 80% of all lung cancers. There is an impetus to find a screening test that can detect non-small cell lung cancer in its early preclinical stages, when surgical resection is most likely to reduce lung cancer mortality. Although earlier randomized controlled trials of lung cancer screening using chest radiography and sputum cytology failed to show reduced lung cancer mortality, CT is a much more sensitive test for detecting small lung nodules, and has generated considerable enthusiasm as a potential contemporary screening tool for lung cancer.
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Affiliation(s)
- Denise R Aberle
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, 924 Westwood Boulevard, Suite 420, Los Angeles, CA 90024, USA.
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Patz EF. Lung Cancer Screening, Overdiagnosis Bias, and Reevaluation of the Mayo Lung Project. ACTA ACUST UNITED AC 2006; 98:724-5. [PMID: 16757691 DOI: 10.1093/jnci/djj226] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Krupnick AS, Kreisel D, Hope A, Bradley J, Govindan R, Meyers B. Recent Advances and Future Perspectives in the Management of Lung Cancer. Curr Probl Surg 2005; 42:540-610. [PMID: 16087000 DOI: 10.1067/j.cpsurg.2005.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Manser RL, Dodd M, Byrnes G, Irving LB, Campbell DA. Incidental lung cancers identified at coronial autopsy: implications for overdiagnosis of lung cancer by screening. Respir Med 2005; 99:501-7. [PMID: 15763458 DOI: 10.1016/j.rmed.2004.08.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The extent to which overdiagnosis occurs in lung cancer screening programmes has been debated. Overdiagnosis refers to the detection by screening of cancers that would not have become clinically apparent or symptomatic before that individual died of other causes. METHODS A retrospective review of coronial autopsies performed in Victoria between April 1991 and February 2002 was conducted to determine the rate of incidental lung cancer in individuals who died of natural causes. RESULTS A total of 24,708 autopsy reports were searched electronically. We estimated that in 56% of these death was from natural causes. Amongst individuals who died naturally there were 167 cases of lung cancer, 47 of these were incidental including five carcinoid tumours, three small cell tumours, 11 cases of carcinoma in situ and 28 invasive nonsmall cell lung cancers. Of the incidental invasive nonsmall cell lung cancers, 86% were stage I. CONCLUSIONS Although incidental lung cancer is uncommon, there are some lung cancers that remain undetected during life and do not contribute to death. These findings support the hypothesis that some lung cancers detected by screening may never progress to cause symptoms or death in that individual's lifetime and therefore may be overdiagnosed by screening.
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Affiliation(s)
- Renee L Manser
- Clinical Epidemiology and Health Service Evaluation Unit, Royal Melbourne Hospital, Ground Floor Charles Connibere Building, Grattan Street, Parkville 3050, Victoria, Australia.
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Abstract
Lung cancer is the leading cause of cancer death in the United States. Despite evidence of molecular abnormalities in biological specimens, progress in this disease is hampered by the lack of diagnostic markers useful for clinical practice. The majority of patients with lung cancer are still diagnosed at an advanced stage, when prognosis is poor. This article reviews new strategies being studied for the early detection of lung cancer. These strategies involve new methods of imaging (including low-dose computed tomography [CT] scanning), DNA analysis, and proteomic-based techniques. These strategies have not only improved our understanding of lung cancer but show promise in offering better survival to patients with this deadly disease. Of paramount importance in the search for methods of early detection is the need for the identification of the ideal population to screen, a multidisciplinary approach, and validation of promising techniques.
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Affiliation(s)
- Noel R Wardwell
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt Ingram Comprehensive Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Manser R, Dalton A, Carter R, Byrnes G, Elwood M, Campbell DA. Cost-effectiveness analysis of screening for lung cancer with low dose spiral CT (computed tomography) in the Australian setting. Lung Cancer 2005; 48:171-85. [PMID: 15829317 DOI: 10.1016/j.lungcan.2004.11.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2004] [Revised: 11/01/2004] [Accepted: 11/03/2004] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Low dose spiral computed tomography (CT) is a sensitive screening tool for lung cancer that is currently being evaluated in both non-randomised studies and randomised controlled trials. METHODS We conducted a quantitative decision analysis using a Markov model to determine whether, in the Australian setting, offering spiral CT screening for lung cancer to high risk individuals would be cost-effective compared with current practice. This exploratory analysis was undertaken predominantly from the perspective of the government as third-party funder. In the base-case analysis, the costs and health outcomes (life-years saved and quality-adjusted life years) were calculated in a hypothetical cohort of 10,000 male current smokers for two alternatives: (1) screen for lung cancer with annual CT for 5 years starting at age 60 year and treat those diagnosed with cancer or (2) no screening and treat only those who present with symptomatic cancer. RESULTS For male smokers aged 60-64 years, with an annual incidence of lung cancer of 552 per 100,000, the incremental cost-effectiveness ratio was 57,325 dollars per life-year saved and 105,090 dollars per QALY saved. For females aged 60-64 years with the same annual incidence of lung cancer, the cost-effectiveness ratio was 51,001 dollars per life-year saved and 88,583 dollars per QALY saved. The model was used to examine the relationship between efficacy in terms of the expected reduction in lung cancer mortality at 7 years and cost-effectiveness. In the base-case analysis lung cancer mortality was reduced by 27% and all cause mortality by 2.1%. Changes in the estimated proportion of stage I cancers detected by screening had the greatest impact on the efficacy of the intervention and the cost-effectiveness. The results were also sensitive to assumptions about the test performance characteristics of CT scanning, the proportion of lung cancer cases overdiagnosed by screening, intervention rates for benign disease, the discount rate, the cost of CT, the quality of life in individuals with early stage screen-detected cancer and disutility associated with false positive diagnoses. Given current knowledge and practice, even under favourable assumptions, reductions in lung cancer mortality of less than 20% are unlikely to be cost-effective, using a value of 50,000 dollars per life-year saved as the threshold to define a "cost-effective" intervention. CONCLUSION The most feasible scenario under which CT screening for lung cancer could be cost-effective would be if very high-risk individuals are targeted and screening is either highly effective or CT screening costs fall substantially.
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Affiliation(s)
- Renee Manser
- Clinical Epidemiology and Health Service Evaluation Unit, Ground Floor Charles Connibere Building, Royal Melbourne Hospital, Grattan Street, Parkville, Vic. 3050, Australia.
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Affiliation(s)
- Janie M Lee
- Massachusetts General Hospital, Department of Radiology, Institute for Technology Assessment, 101 Merrimac Street, 10th Floor, Boston, MA 02114, USA
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Swensen SJ, Jett JR, Hartman TE, Midthun DE, Sloan JA, Sykes AM, Aughenbaugh GL, Clemens MA. Lung cancer screening with CT: Mayo Clinic experience. Radiology 2003; 226:756-61. [PMID: 12601181 DOI: 10.1148/radiol.2263020036] [Citation(s) in RCA: 450] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate a large cohort of patients at high risk for lung cancer by using screening with low-dose spiral computed tomography (CT) of the chest. MATERIALS AND METHODS A prospective cohort study was performed with 1,520 individuals aged 50 years or older who had smoked 20 pack-years or more. Participants underwent three annual low-dose CT examinations of the chest and upper abdomen. Characteristics of pulmonary nodules and additional findings were tabulated and analyzed. RESULTS Two years after baseline CT scanning, 2,832 uncalcified pulmonary nodules were identified in 1,049 participants (69%). Forty cases of lung cancer were diagnosed: 26 at baseline (prevalence) CT examinations and 10 at subsequent annual (incidence) CT examinations. CT alone depicted 36 cases; sputum cytologic examination alone, two. There were two interval cancers. Cell types were as follows: squamous cell tumor, seven; adenocarcinoma or bronchioloalveolar carcinoma, 24; large cell tumor, two; non-small cell tumor, three; small cell tumor, four. The mean size of the non-small cell cancers detected at CT was 15.0 mm. The stages were as follows: IA, 22; IB, three; IIA, four; IIB, one; IIIA, five; IV, one; limited small cell tumor, four. Twenty-one (60%) of the 35 non-small cell cancers detected at CT were stage IA at diagnosis. Six hundred ninety-six additional findings of clinical importance were identified. CONCLUSION CT can depict early-stage lung cancers. The rate of benign nodule detection is high.
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Affiliation(s)
- Stephen J Swensen
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Black WC. Invited Commentary • Author's Response. Radiographics 2002. [DOI: 10.1148/rg.226025140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Affiliation(s)
- Stephen J Swensen
- Department of Radiology, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA
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Koyi H, Hillerdal G, Brandén E, Nordesjö LO. The 'reservoir' of undetected bronchial carcinomas in the general population. Lung Cancer 2002; 37:137-42. [PMID: 12140135 DOI: 10.1016/s0169-5002(02)00041-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVES Autopsy studies have shown that a sizeable portion of lung cancers are never diagnosed and thus not entered into any cancer registry. DESIGN In 1997, we decided to make all available efforts to find all patients with lung cancer who had not been registered previously. SETTING The local hospitals in the county of Gävleborg, Sweden. PATIENTS All patients with lung cancer diagnosed in the county from 1997 to 2000. INTERVENTIONS In meetings with all the general practitioners of the county, these were asked to refer all suspected cases as early as possible, including those with a seemingly dismal prognosis. This initiative was also covered by the newspapers and the local television station. MEASUREMENTS AND RESULTS From 1997 onwards, the incidence of lung cancer in the county was found to be 40-50 per 100,000 inhabitants compared with an incidence of about 30 during the ten preceding years. This difference is significant in time (P<0.0001) and is compared with the incidence of lung cancers in four neighboring counties (P=0.002). CONCLUSIONS There can be a considerable number of patients with lung cancer who are never diagnosed. This can explain differences in survival between various countries and this will also affect the results of screening programs, since the control groups will also include a number of lung cancer cases which will never be recognized.
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Affiliation(s)
- Hirsh Koyi
- Department of Respiratory Medicine, Gävleborg County Hospital, 801-87 Gävle, Sweden.
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Abstract
Although spiral CT has an undeniably impressive ability to detect occult lung cancers in asymptomatic smokers, it is not clear whether screening this patient group will lead to a reduction in disease-specific mortality. The specter of overdiagnosis in lung cancer screening, which manifested during the chest radiograph trials of the 1970s and 1980s, still hangs over screening regimes today. The detection of premalignant lesions by molecular medicine techniques and fluorescence bronchoscopy may allow the development of novel treatments for preinvasive disease, but it is likely that radiologic means of detection will form the front line of any near future screening program. The proposed screening techniques may be new, but their use must be tested against tried and trusted standards of medical practice.
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Affiliation(s)
- Steven Woloshin
- Veterans Affairs Outcomes Group, Veterans Affairs Medical Center, White River Junction, VT 05009, USA.
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Patz EF, Black WC, Goodman PC. CT screening for lung cancer: not ready for routine practice. Radiology 2001; 221:587-91; discussion 598-9. [PMID: 11719648 DOI: 10.1148/radiol.2213001643] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lung cancer continues to be a major worldwide health problem. Multiple strategies are being explored in an attempt to reduce lung cancer mortality, including a renewed interest in screening. Multiple low-dose spiral computed tomography (CT) trials have been proposed, as proponents predict that small nodules will represent early-stage disease and detecting them will ultimately translate into improvements in outcomes. At this time, however, only prevalence-screening data are available, and it remains to be seen if CT will truly reduce mortality. The appropriate hypothesis-driven studies still must be performed and the results carefully analyzed before CT screening for lung cancer can be accepted as the standard of care.
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Affiliation(s)
- E F Patz
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
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Ellis SM, Husband JE, Armstrong P, Hansell DM. Computed tomography screening for lung cancer: back to basics. Clin Radiol 2001; 56:691-9. [PMID: 11585391 DOI: 10.1053/crad.2001.0850] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
After some years in the doldrums, interest in screening for lung cancer is resurging. Conflicting evidence from previous lung cancer screening trials, based on plain chest radiography, has been the subject of much debate: the failure to demonstrate a reduction in mortality has led to the widely held conclusion that screening for lung cancer is ineffective. The validity of this assumption has been questioned sporadically and a large study currently under way in the U.S.A. should help settle the issue. Recently, there has been interest in the use of computed tomography to screen for lung cancer; radiation doses have been reduced to 'acceptable' levels and the superiority of computed tomography (CT) over chest radiography for the identification of pulmonary nodules is unquestioned. However, whether improved nodule detection will result in a reduction in mortality has not yet been demonstrated. The present review provides a historical background to the current interest in low-dose CT screening, explains the arguments that previous studies have provoked, and discusses the recent and evolving status of lung cancer screening with CT. Ellis, S. M. et al. (2001).
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Affiliation(s)
- S M Ellis
- Department of Radiology, Royal Brompton Hospital, London, U.K
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Abstract
BACKGROUND Randomized controlled trials (RCTs) of lung cancer screening consistently show an excess number of cancer cases and longer survival in screened groups, but no difference in mortality between screened and control populations. METHODS The current study reviewed the various types of biases that confuse comparisons based on intermediate endpoints such as stage distribution and survival and the reasons for basing evaluations in RCTs of screening for early cancers on mortality from a specific cancer. RESULTS Four RCTs all showed improved stage of disease and survival in screened subjects, but there was no difference in mortality between screened and unscreened populations. The possible explanations for the higher incidence are chance (failed randomization) or "overdiagnosis" (detection of cases by screening that otherwise would never have surfaced). Analysis of the trial results confirmed that chance alone was a very unlikely explanation. Evidence suggests that some overdiagnosis of lung cancer is likely in screened subjects. This is a consistent observation in all other programs of screening for early cancers (breast, prostate, and neuroblastoma). CONCLUSIONS Overdiagnosis of cancer cases resulting from the screening process itself will give rise to excess cases of disease, and may, at least in part, explain the observations in the randomized trials.
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Affiliation(s)
- D M Parkin
- The International Agency for Research on Cancer, Lyon, France.
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Black WC. Overdiagnosis: An underrecognized cause of confusion and harm in cancer screening. J Natl Cancer Inst 2000; 92:1280-2. [PMID: 10944539 DOI: 10.1093/jnci/92.16.1280] [Citation(s) in RCA: 156] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Benbow EW. Relative friendly death certificates. J Clin Pathol 1993; 46:782. [PMID: 8408714 PMCID: PMC501479 DOI: 10.1136/jcp.46.8.782-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Piette JC, Frances C, Papo T, Karmochkine M. Vasculopathy and antiphospholipid antibodies in systemic lupus. J Clin Pathol 1993; 46:781-2. [PMID: 8408713 PMCID: PMC501477 DOI: 10.1136/jcp.46.8.781-b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Chetty R. Carcinoid pattern in adrenal phaeochromocytomas. J Clin Pathol 1993; 46:782. [PMID: 8104959 PMCID: PMC501478 DOI: 10.1136/jcp.46.8.782-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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