ArticleAnnals of internal medicine2024
Rates of Downstream Procedures and Complications Associated With Lung Cancer Screening in Routine Clinical Practice : A Retrospective Cohort Study.
Article in Annals of internal medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.
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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.
Who cites it
33 citing papers in PubMed, 1 synthesis or guideline pooled it, 46 citations in OpenAlex.
- Time to Benefit for Lung Cancer Screening: A Systematic Review and Survival Meta-Analysis.American journal of preventive medicine · 2025Pooled it
- Screening Eligibility and Survival Among Patients With Lung Cancer in Korea.JAMA network open · 2026Article
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- Reimagining lung screening in women.The British journal of radiology · 2026Article
- Burden and Impact of Frailty and Comorbidity in Individuals Screened for Lung Cancer.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2026Article
- Addressing algorithmic bias in lung cancer screening eligibility.Journal of the National Cancer Institute · 2026Article
- Editorial: Advancing diagnostic excellence in early lung cancer detection.Frontiers in oncology · 2026Article
- Comparison of Underlying Risk of Developing and Dying From Lung Cancer in Screened Populations.Chest · 2026Article
- Bridging the lung cancer screening eligibility gap: evaluation of guideline applicability in asymptomatic patients.Military Medical Research · 2026Observational
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- Monitoring the Harms of Lung Cancer Screening: Why the Nonmalignant Resection Rate Is Our Best Bet.Journal of the American College of Radiology : JACR · 2025Article
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- Updates in Lung Cancer Screening: A Decade of Evidence.Seminars in respiratory and critical care medicine · 2025Review
- A multivariate cell-based liquid biopsy for lung nodule risk stratification: Analytical validation and early clinical evaluation.The journal of liquid biopsy · 2025Article
- Lessons Learned From International Lung Cancer Screening Trials; People at Risk Deserve Screening for Early Detection.Respirology (Carlton, Vic.) · 2025Review
- Patterns of Medical Care Cost by Service Type Associated With Lung Cancer Screening.Medical care · 2025Article
- Leveraging sequences missing from the human genome to diagnose cancer.Communications medicine · 2025Article
- Positive Screens Are More Likely in a National Lung Cancer Screening Registry Than the National Lung Screening Trial.Journal of the American College of Radiology : JACR · 2025Article
Corrections and comments
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Authors and funding
15 authors at 6 institutions in 1 country.
Funding
Abstract
backgroundLung cancer screening (LCS) using low-dose computed tomography (LDCT) reduces lung cancer mortality but can lead to downstream procedures, complications, and other potential harms. Estimates of these events outside NLST (National Lung Screening Trial) have been variable and lacked evaluation by screening result, which allows more direct comparison with trials.
objectiveTo identify rates of downstream procedures and complications associated with LCS.
designRetrospective cohort study.
setting5 U.S. health care systems. PATIENTS: Individuals who completed a baseline LDCT scan for LCS between 2014 and 2018. MEASUREMENTS: Outcomes included downstream imaging, invasive diagnostic procedures, and procedural complications. For each, absolute rates were calculated overall and stratified by screening result and by lung cancer detection, and positive and negative predictive values were calculated.
resultsAmong the 9266 screened patients, 1472 (15.9%) had a baseline LDCT scan showing abnormalities, of whom 140 (9.5%) were diagnosed with lung cancer within 12 months (positive predictive value, 9.5% [95% CI, 8.0% to 11.0%]; negative predictive value, 99.8% [CI, 99.7% to 99.9%]; sensitivity, 92.7% [CI, 88.6% to 96.9%]; specificity, 84.4% [CI, 83.7% to 85.2%]). Absolute rates of downstream imaging and invasive procedures in screened patients were 31.9% and 2.8%, respectively. In patients undergoing invasive procedures after abnormal findings, complication rates were substantially higher than those in NLST (30.6% vs. 17.7% for any complication; 20.6% vs. 9.4% for major complications). LIMITATION: Assessment of outcomes was retrospective and was based on procedural coding.
conclusionThe results indicate substantially higher rates of downstream procedures and complications associated with LCS in practice than observed in NLST. Diagnostic management likely needs to be assessed and improved to ensure that screening benefits outweigh potential harms. PRIMARY FUNDING SOURCE: National Cancer Institute and Gordon and Betty Moore Foundation.
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