Summary of the 12 studies included in the review of clinical effectiveness
| No. | Study | Participants | Screen interval | Number screened | Positive screen(% of screened) | Biopsy (% of screened; % screened positive)† | Total lung cancer (% of screened; % screened positive); NNS‡ | Number of NSCLC | Stage 1 for NSCLC (% of NSCLC) NNS§ | Resectable lesion (% of NSCLC) | Outcomes¶ |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BL, baseline screening; FU, follow-up; NNS, number needed to screen; NR, not reported; NSCLC, non-small-cell lung cancer; pkyr, pack years; SCLC, small-cell lung cancer. | |||||||||||
| INC refers to “incidence scans”—that is, each participant has had at least one previous scan so risk is percentage of the total “incidence scans”. | |||||||||||
| *RCT comparing computed tomography to chest x ray. Chest x ray arm reported in table but not included in any of the further analysis of the trials as chest x ray not being considered by this review. | |||||||||||
| †Biopsy recommended (not necessarily conducted and some under go biopsy against advice—these are not included. | |||||||||||
| ‡Number needed to screen to identify one lung cancer. §Number needed to screen to identify one stage I lung cancer. | |||||||||||
| ¶No mortality rates reported. Some studies did report deaths but insufficient denominator data; others only reported deaths among those with lung cancer. | |||||||||||
| RANDOMISED CONTROLLED TRIALS | |||||||||||
| 1 | Gohagan et al, 2004, USA* Main ref:22 Other ref: NA | 55–74 year, 30 pkyr, quit <10 year | single CT v CXR | CT: 1586 CXR: 1550 | CT: 325 (20.5%) CXR: 152 (9.8%) | CT: 53 (3%; 16%) CXR: 15 | CT: 30 (1.9%; 9.2%) CXR: 7 NNS = 53 | CT: 29 CXR: 7 | CT: 16 (53%) CXR: 6 NNS = 99 | NR | NR |
| 2 | Garg 2002– USA Main ref:21 Other ref: NA | 50–80 year, Atypical sputum cytology + COPD, or 30 pkyr | single CT v no screening | CT: 92 none: 98 | CT: 30 (33%) | 2 (2 reported but 3 cancers, one not discussed in text) | CT: 3 (3.2%; 10%) NNS = 31 | CT: 2 | NR | NR | NR |
| STUDIES WITHOUT COMPARATOR GROUPS (All participants screened with CT) | |||||||||||
| 3 | ELCAP 2001– USA Main ref:17 Other ref:23–26 | + 60 year, 10 pkyr smoking | annual | Baseline: 1000 Yr1: 841 Yr2: 343 (Incidence screens: 1184) | Baseline: 233 (23.3%) Incidence: 40 (3.4%) | Baseline 30 (3%; 13%) Incidence: 8 (0.7%; 20%) | Baseline: 27 (2.7%; 11.6%) Incidence: 7 (0.6%; 17.5%) Interval: 2 NNS = 37 (BL); 169 (INC) | Baseline 26 Incidence: 6 Interval: 1 | Baseline: 23 (88%) Incidence: 5 (71%) | Baseline: 27 (100%) Incidence: 6 (100%) NNS = 37 (BL); 197 (INC) | Baseline All with cancer alive at mean 2.5 year 5 died of other causes |
| 4 | Kaneko (Sobue) 2002– Japan Main ref:27 Other ref:28,29 | +40 year, 20 pkyr smoking | twice per year | Baseline: 1611 Incidence: 7891 (>5 years) | Baseline: 186 (11.5%) Incidence: 721 (9.1%) | Baseline: 21 (1.3%; 11.3%) Incidence: 35 (0.4%; 4.9%) | Baseline: 13 (0.8%; 7.0%) Incidence: 19 (0.2%; 2.6%) NNS = 115 (BL); 420 (INC) | Baseline: 13 Incidence: 18 | Baseline: 10 (77%) Incidence: 15 (83%) | Baseline: 12 (92%) Incidence: 17 (89%) NNS = 134(BL); 464 (INC) | Baseline: 76.2% 5-year survival Incidence: 64.9% 5-year survival |
| 5 | Diederich 2004– Germany Main ref:30 Other ref:31 | +40 year, 20 pkyr smoking | Annual | Baseline: 817 Year 1: 668 Year 2: 549Year 3: 366 Year 4: 128 Year 5: 24 (incidence 1735) | Baseline: 350 (43%) Incidence: 89 (5.1%) | Baseline 13 (1.6%; 3.7%) Incidence 5 (0.3%; 6%) | Baseline: 17 (2.1%; 4.9%) Incidence: 3 (0.2%; 3.4%) Interval 5 NNS = 48 (BL); 578 (INC) | Baseline 16 Incidence 3 Interval: 3 | Baseline: 9 (56%) Incidence: 1 (33%) | Baseline: 16 (100%) Incidence: 3 (100%) NNS = 51(BL); 578 (INC) | Baseline 4 Lung cancer deaths 1 sudden death (at mean 27mth follow-up) Incidence: 2 lung cancer deaths |
| 6 | Sone 2001– Japan Main ref:32 Other ref:33–36 | +40 year, smokers and non-smokers (was a comparator group but not reported further) | annual | Baseline: 5483 Year 1 4425 Year 2 3878 (incidence 8303) | Baseline: 279 (5.1%) Incidence: 309 (3.7%) | Baseline: 29 (0.5%; 10%) Incidence 43 (0.5%; 14%) | Baseline: 22 (0.4%; 7.9%) Incidence: 34 (0.4%; 11%) Interval: 4 NNS = 249 (BL); 755 (INC) | Baseline: 22 Incidence NR | Baseline: 22 (100%) Incidence: NR | Baseline: 22 (100%) Incidence: 34 (100%) NNS = 249(BL); 755 (INC) | 2 Lung cancer deaths 3 died other cause 51 disease free (1.2–3.7 year FU) |
| 7 | Swensen 2003- USA Main ref:37 Other ref:38–40 | +50 year, 20 pkyr, quit <10 year | annual | Baseline: 1520 Year 1 1478 Year 2 1438 (incidence 2916) | Baseline: 782 (51%) Incidence: 336 (11.5%) | NR 8 resections of benign disease | Baseline: 26 (1.7%; 3.3%) Incidence: 9 (0.3%; 2.7%) Interval: 2 + 2 by sputum only NNS = 58 (BL); 324 (INC) | Baseline 24 Incidence: 9 Interval: 1 | Baseline: 18 (69%) Incidence: 6 (63%) | 31 of 40 tumours resected No surgical deaths | Deaths in 3 years: 2 SCLC 3 NSCLC 4 heart disease 2 infection 5 Cancer other 1 Suicide 2 Unknown |
| 8 | Pastorino 2003 - Italy Main ref:41 Other ref: NA | +50 year, 20 pkyr | annual | Baseline: 1035 Incidence: 996 | Baseline: 61 (5.9%) Incidence: 34 (3.4%) | Baseline: 11 (1.1%; 18%) Incidence: 11 (1%; 33%) 6 benign lesions resected | Baseline: 11 (1.1%; 18%) Incidence: 11 (1.1%; 32%) Interval: 0 NNS = 94 (BL); 91 (INC) | Baseline: 11 Incidence: 11 | Baseline: 6 (55%) Incidence: 11 (100%) | Baseline: 10 (91%) Incidence: 11 (100%) NNS = 104(BL); 91 (INC) | Lung Cancer: 1 dead 3 recurrence 18 alive (at mean 2.5 year) No Lung cancer: 7 deaths (3 vascular) |
| 9 | Nawa 2002– Japan Main ref:42 Other ref: | +50 year, smokers and non-smokers, employee health insurance group | annual | Baseline: 7956 Incidence: 5568 | Baseline: 541 (6.8%) Incidence: 148 (2.7%) | Further investigation: Baseline: 64 (0.8%; 11.8%) Incidence: 7 (0.1%; 4.7%) | Baseline: 36 (0.45%; 6.7%) Incidence: 4 (0.07%; 2.7%) NNS = 221 (BL); 1392 (INC) | Baseline: 35 Incidence: 4 | Baseline: 31 (86%) Incidence: 4 (100%) | NR | 4 other cancers identified |
| 10 | MacRedmond 2004– Ireland Main ref:43 Other ref: NA | +50 year, 10 pkyr, still smoking at 45 year | annual | Baseline: 449 | Baseline: 109 (24%) | Baseline 9 (2%; 8%) | Baseline: 2 (0.4%; 1.8%) NNS = 225 (BL); | Baseline: 1 | Baseline: NR | Baseline: 1 (100%) NNS = 449(BL) | Incidental findings: 61.5% 1 death from pancreatic cancer |
| 11 | Huuskonen 2002– Finland Main ref:44 Other ref:45 | <75 year, smoked 10 year, asbestos-related occupational disease | single scan | Baseline: 602 | Baseline: 111 (18.4%) | Baseline 30 (5%; 27%) | Baseline: 5 (0.8%; 4.5%) (1 missed on biopsy- diagnosed at 12mth FU) NNS = 120 (BL); | Baseline: 5 | Baseline: 0 | Baseline: 1 (20%) NNS = 602(BL); | 5 died within 21 months; 1 surviving FU not stated Incidental: 1 peritoneal mesothelioma |
| 12 | Miller 2004– USA Main ref:46 Other ref: NA | Nuclear fuel workers | 18 monthly | Baseline: 3598 | Baseline: 1139 (32%) | NR | Baseline: 22 (0.61%; 1.9%) One “incidence” tumour reported but no mention of incidence scans NNS = 163 (BL); | Baseline: 21 | Not available for all | Too poorly reported | NR |