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Intervention Review

Screening for lung cancer

  1. Renée Manser1,*,
  2. Louis B Irving2,
  3. Christine Stone3,
  4. Graham Byrnes4,
  5. Michael J Abramson5,
  6. Donald Campbell6

Editorial Group: Cochrane Lung Cancer Group

Published Online: 26 JAN 2004

Assessed as up-to-date: 10 JAN 2009

DOI: 10.1002/14651858.CD001991.pub2


How to Cite

Manser R, Irving LB, Stone C, Byrnes G, Abramson MJ, Campbell D. Screening for lung cancer. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD001991. DOI: 10.1002/14651858.CD001991.pub2.

Author Information

  1. 1

    Peter MacCallum Cancer Institute, Department of Haematology and Medical Oncology, Victoria, Australia

  2. 2

    Royal Melbourne Hospital, Respiratory and Sleep Medicine, Parkville, Victoria, Australia

  3. 3

    Department of Human Services, Victoria, Prevention and National Health Priorities, Melbourne, Victoria, Australia

  4. 4

    University of Melbourne, Department of Mathematics and Statistics, Melbourne, Victoria, Australia

  5. 5

    Monash University, Epidemiology & Preventive Medicine, Melbourne, Victoria, Australia

  6. 6

    Monash Institute of Health Services Research, Clayton, Victoria, Australia

*Renée Manser, Department of Haematology and Medical Oncology, Peter MacCallum Cancer Institute, St Andrews Place, East Melbourne 3002, Victoria, Australia. Renee.Manser@petermac.org.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 26 JAN 2004

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Population based screening for lung cancer has not been adopted in the majority of countries, however it is not clear whether sputum examinations, chest radiography or newer methods such as computed tomography (CT) are effective in reducing mortality from lung cancer.

Objectives

To determine whether screening for lung cancer, using regular sputum examinations, chest radiography or CT scanning of the chest, reduces lung cancer mortality.

Search methods

We searched electronic databases (the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 4), MEDLINE (1966 to 2007), PREMEDLINE and EMBASE (to 2007)) and bibliographies. We handsearched the journal Lung Cancer (to 2000) and contacted experts in the field to identify published and unpublished trials.

Selection criteria

Controlled trials of screening for lung cancer using sputum examinations, chest radiography or chest CT.

Data collection and analysis

We performed an intention-to-screen analysis. Where there was significant statistical heterogeneity, we reported relative risks (RR) using the random-effects model. For other outcomes we used the fixed-effect model.

Main results

We included seven trials (six randomised controlled studies and one non-randomised controlled trial) with a total of 245,610 subjects. There were no studies with an unscreened control group. Frequent screening with chest x-rays 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). We observed a non-statistically significant trend to reduced mortality from lung cancer when screening with chest x-ray and sputum cytology was compared with chest x-ray alone (RR 0.88, 95% CI 0.74 to 1.03). Several of the included studies had potential methodological weaknesses. There were no controlled studies of spiral CT.

Authors' conclusions

The current evidence does not support screening for lung cancer with chest radiography or sputum cytology. Frequent chest x-ray screening might be harmful. Further methodologically rigorous trials are required.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Not enough evidence to support regular screening for lung cancer

Lung cancer is the most common cause of cancer related death in the western world. It takes about 20 years to develop and cigarette smoking is a known cause. Most lung cancers are not found early in the development of the disease. Regular screening is offered to those considered to be at high risk of contracting the disease. Trials were made of early detection methods such as the testing of sputum, x-ray and computed tomography (CT) scanning of the chest to see whether they made a difference to the number of people who were treated by surgery and the number of people who died as a result of the disease. This review examined the evidence from the trials and found that the early screening does not appear to have much impact on either. The review found that frequent chest x-ray may cause harm to the patient. More research is needed in this area.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

肺癌的篩檢

雖然大多數的國家仍未接受以群眾為基礎的肺癌篩檢,但是以痰液檢驗、胸部X光片或更新的方法如胸部電腦斷層來做肺癌篩檢能否有效降低肺癌死亡率仍不清楚

目標

探討以定期的痰液檢驗或胸部X光片或胸部電腦斷層來做肺癌篩檢是否能降低肺癌死亡率

搜尋策略

電子資料庫 (the Cochrane Central Register of Controlled Trials, MEDLINE, PREMEDLINE and EMBASE; 1966年到2000年7月) 、書籍、人工期刊查閱以及專家討論都用來分辨發表以及未發表的試驗。

選擇標準

利用痰液檢驗、胸部X光片或胸部電腦斷層來做肺癌篩檢的控制試驗

資料收集與分析

使用篩檢意向分析法。在有顯著的統計異質性時,使用隨機效應模型來呈現相對風險值,其他的預後值則使用固定效應模型。

主要結論

蒐集了7個試驗(6個是隨機對照試驗,1個是非隨機對照試驗),總共有245610筆資料,沒有一個試驗有無篩檢對照組。較頻繁的胸部X光檢查比起較不頻繁的胸部X光檢查增加了11%肺癌死亡率(RR 1.11, CI: 1.00 – 1.23)。合併使用胸部X光和痰液檢查和單獨使用胸部X光檢查相比,觀察到一個未達統計學意義的趨勢,顯示可減少肺癌的死亡率(RR 0.88, CI:0.74 – 1.03)。其中好幾個試驗中都有研究方法的潛在弱點。也沒有螺旋式電腦斷層的對照研究。

作者結論

目前的證據並不支持以胸部X光片或痰液檢驗來做肺癌篩檢,頻繁的胸部X光檢查也許是有害的。此外,我們需要更多研究方法學上設計嚴密的試驗。

翻譯人

本摘要由臺北榮民總醫院葉尚倫翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有足夠的證據支持定期的肺癌篩檢。 在西方世界,肺癌是最常見的癌症致死因。它大約花20年形成,抽菸是已知的致病因子。大部份的肺癌都是到了末期才被發現,定期篩檢只有在高危險群才考慮實施。回顧這些試驗發現無論是痰液檢驗、胸部X光片還是胸部電腦斷層等早期檢測都無法對肺癌的治療或死亡率的減少產生影響。這個回顧甚至發現頻繁的胸部X光檢查也許是有害的。我們需要更多的研究。