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Screening for lung cancer

  1. RL Manser Research Fellow*,
  2. LB Irving,
  3. C Stone,
  4. G Byrnes,
  5. M Abramson,
  6. D Campbell

Editorial Group: Cochrane Lung Cancer Group

Published Online: 6 SEP 1999

DOI: 10.1002/14651858.CD001991

How to Cite

Manser, R., Irving, L., Stone, C., Byrnes, G., Abramson, M., Campbell, D. 1999. Screening for lung cancer

Author Information

  1. Royal Melbourne Hospital, Clinical Epidemiology and Health Service Evaluation Unit, Victoria, AUSTRALIA

*RL Manser, Research Fellow, Clinical Epidemiology and Health Service Evaluation Unit, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, 3050, AUSTRALIA. ManserRL@mh.org.au.

Publication History

  1. Published Online: 6 SEP 1999

SEARCH

This is not the most recent version of the article. View current version (21 JUN 2013)

 

Abstract

  1. Top of page
  2. Abstract
  3. Synopsis

Background

While population based screening for lung cancer has not been adopted by most countries, it is not clear whether sputum examinations, chest radiography or newer methods such as computed tomography are effective in reducing mortality from lung cancer.

Objectives

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

Search strategy

Electronic databases (the Cochrane Central Register of Controlled Trials, MEDLINE, PREMEDLINE and EMBASE; 1966 to July 2000) ), bibliographies, hand searching of a journal and discussion with experts were used to identify published and unpublished trials.

Selection criteria

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

Data collection and analysis

Intention to screen analysis was performed. Where there was significant statistical heterogeneity relative risks were reported using the random effect model, but for other outcomes the fixed effect model was used.

Main results

Seven trials were included (6 randomised controlled studies and 1 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, CI: 1.00-1.23). A non statistically significant trend was observed 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, CI:0.74-1.03). Several of the included studies had potential methodological weaknesses. There were no controlled studies of spiral CT.

Reviewer's 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.

 

Synopsis

  1. Top of page
  2. Abstract
  3. Synopsis

Synopsis

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 until they are advanced but regular screening is offered to those considered at high risk of the disease. The review of trials found early detection methods such as chest x-ray, testing sputum or CT scan do not appear to have much impact on either treatment or number of deaths from lung cancer. The review found frequent chest x-ray may cause harm. More research is needed.