Evidence map›Paper›PMID 38072977›Full record

ArticleDiagnostic and prognostic research2023

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.

Emma Duer, Huiqin Yang, Sophie Robinson, Bogdan Grigore, Josie Sandercock, Tristan Snowsill, Ed Griffin, Jaime Peters, Chris Hyde

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In one paragraph

Article in Diagnostic and prognostic research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Emma DuerQueen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK.
Huiqin YangSchool of Healthcare, Faculty of Medicine & Health, University of Leeds, Leeds, UK.
Sophie RobinsonEvidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK.
Bogdan GrigoreExeter Test Group, University of Exeter Medical School, Room 1.22 College House, St Luke's Campus, Exeter, EX1 2LU, UK.
Josie SandercockSystematic Review Initiative, NHS Blood & Transplant, Oxford, UK.
Tristan SnowsillHealth Economics Group, University of Exeter Medical School, Exeter, UK.
Ed GriffinExeter Test Group, University of Exeter Medical School, Room 1.22 College House, St Luke's Campus, Exeter, EX1 2LU, UK.
Jaime PetersExeter Test Group, University of Exeter Medical School, Room 1.22 College House, St Luke's Campus, Exeter, EX1 2LU, UK.
Chris HydeExeter Test Group, University of Exeter Medical School, Room 1.22 College House, St Luke's Campus, Exeter, EX1 2LU, UK. c.j.hyde@exeter.ac.uk.ORCID http://orcid.org/0000-0002-7349-0616

Funding

Health Technology Assessment Programme UK NIHR Health Technology Assessment Programme (14/151/07).
6 · The paper itself

Abstract

backgroundFor people at high risk of lung cancer, low-dose computed tomography (LDCT) is proposed as a method to reduce mortality.

methodsOur 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.

resultsNine 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.

conclusionsLDCT 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.

Indexed as

Early detection of cancerLung neoplasmsMass screeningReviewSpiral computedSystematicTomographyX-ray computed tomography

Identifiers

PMID38072977
PMCPMC10712083

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.