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Screening for lung cancer: a systematic review and meta-analysis of controlled trials
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  1. R L Manser1,
  2. L B Irving2,
  3. G Byrnes3,
  4. M J Abramson4,
  5. C A Stone5,
  6. D A Campbell6
  1. 1Clinical Epidemiology and Health Service Evaluation Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia and Department of Respiratory Medicine, St Vincent’s Hospital, Fitzroy, Victoria, Australia
  2. 2Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
  3. 3Department of Mathematics and Statistics, University of Melbourne, Victoria, Australia
  4. 4Department of Epidemiology and Preventive Medicine, Monash Medical School, The Alfred Hospital, Prahran, Victoria, Australia
  5. 5Public Health Division, Department of Human Services, Melbourne, Victoria, Australia
  6. 6Clinical Epidemiology and Health Service Evaluation Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
  1. Correspondence to:
    Dr R Manser, Clinical Epidemiology and Health Service Evaluation Unit, Ground Floor, Charles Connibere Building, Royal Melbourne Hospital, Grattan Street, Parkville 3050, Victoria, Australia;
    ManserRL{at}mh.org.au

Abstract

Background: Lung cancer is a substantial public health problem in western countries. Previous studies have examined different screening strategies for lung cancer but there have been no published systematic reviews.

Methods: A systematic review of controlled trials was conducted to determine whether screening for lung cancer using regular sputum examinations or chest radiography or computed tomography (CT) reduces lung cancer mortality. The primary outcome was lung cancer mortality; secondary outcomes were lung cancer survival and all cause mortality.

Results: One non-randomised controlled trial and six randomised controlled trials with a total of 245 610 subjects were included in the review. In all studies the control group received some type of screening. More frequent screening with chest radiography was associated with an 11% relative increase in mortality from lung cancer compared with less frequent screening (RR 1.11, 95% CI 1.00 to 1.23). A non-statistically significant trend to reduced mortality from lung cancer was observed when screening with chest radiography and sputum cytological examination was compared with chest radiography alone (RR 0.88, 95% CI 0.74 to 1.03). Several of the included studies had potential methodological weaknesses. Controlled studies of spiral CT scanning have not been reported.

Conclusions: The current evidence does not support screening for lung cancer with chest radiography or sputum cytological examination. Frequent chest radiography might be harmful. Further methodologically rigorous trials are required before any new screening methods are introduced into clinical practice.

  • meta-analysis
  • lung cancer
  • screening
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Footnotes

  • Sources of support: RLM is supported by a National Health and Medical Research Council scholarship (no 201713).

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