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Overdiagnosis in low-dose computed tomography screening for lung cancer.

Publication ,  Journal Article
Patz, EF; Pinsky, P; Gatsonis, C; Sicks, JD; Kramer, BS; Tammemägi, MC; Chiles, C; Black, WC; Aberle, DR; NLST Overdiagnosis Manuscript Writing Team,
Published in: JAMA Intern Med
February 1, 2014

IMPORTANCE: Screening for lung cancer has the potential to reduce mortality, but in addition to detecting aggressive tumors, screening will also detect indolent tumors that otherwise may not cause clinical symptoms. These overdiagnosis cases represent an important potential harm of screening because they incur additional cost, anxiety, and morbidity associated with cancer treatment. OBJECTIVE: To estimate overdiagnosis in the National Lung Screening Trial (NLST). DESIGN, SETTING, AND PARTICIPANTS: We used data from the NLST, a randomized trial comparing screening using low-dose computed tomography (LDCT) vs chest radiography (CXR) among 53 452 persons at high risk for lung cancer observed for 6.4 years, to estimate the excess number of lung cancers in the LDCT arm of the NLST compared with the CXR arm. MAIN OUTCOMES AND MEASURES: We calculated 2 measures of overdiagnosis: the probability that a lung cancer detected by screening with LDCT is an overdiagnosis (PS), defined as the excess lung cancers detected by LDCT divided by all lung cancers detected by screening in the LDCT arm; and the number of cases that were considered overdiagnosis relative to the number of persons needed to screen to prevent 1 death from lung cancer. RESULTS: During follow-up, 1089 lung cancers were reported in the LDCT arm and 969 in the CXR arm of the NLST. The probability is 18.5% (95% CI, 5.4%-30.6%) that any lung cancer detected by screening with LDCT was an overdiagnosis, 22.5% (95% CI, 9.7%-34.3%) that a non-small cell lung cancer detected by LDCT was an overdiagnosis, and 78.9% (95% CI, 62.2%-93.5%) that a bronchioalveolar lung cancer detected by LDCT was an overdiagnosis. The number of cases of overdiagnosis found among the 320 participants who would need to be screened in the NLST to prevent 1 death from lung cancer was 1.38. CONCLUSIONS AND RELEVANCE: More than 18% of all lung cancers detected by LDCT in the NLST seem to be indolent, and overdiagnosis should be considered when describing the risks of LDCT screening for lung cancer.

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Published In

JAMA Intern Med

DOI

EISSN

2168-6114

Publication Date

February 1, 2014

Volume

174

Issue

2

Start / End Page

269 / 274

Location

United States

Related Subject Headings

  • United States
  • Tomography, X-Ray Computed
  • Time Factors
  • Survival Rate
  • Reproducibility of Results
  • Prospective Studies
  • Probability
  • Middle Aged
  • Mass Screening
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Patz, E. F., Pinsky, P., Gatsonis, C., Sicks, J. D., Kramer, B. S., Tammemägi, M. C., … NLST Overdiagnosis Manuscript Writing Team, . (2014). Overdiagnosis in low-dose computed tomography screening for lung cancer. JAMA Intern Med, 174(2), 269–274. https://doi.org/10.1001/jamainternmed.2013.12738
Patz, Edward F., Paul Pinsky, Constantine Gatsonis, Jorean D. Sicks, Barnett S. Kramer, Martin C. Tammemägi, Caroline Chiles, William C. Black, Denise R. Aberle, and Denise R. NLST Overdiagnosis Manuscript Writing Team. “Overdiagnosis in low-dose computed tomography screening for lung cancer.JAMA Intern Med 174, no. 2 (February 1, 2014): 269–74. https://doi.org/10.1001/jamainternmed.2013.12738.
Patz EF, Pinsky P, Gatsonis C, Sicks JD, Kramer BS, Tammemägi MC, et al. Overdiagnosis in low-dose computed tomography screening for lung cancer. JAMA Intern Med. 2014 Feb 1;174(2):269–74.
Patz, Edward F., et al. “Overdiagnosis in low-dose computed tomography screening for lung cancer.JAMA Intern Med, vol. 174, no. 2, Feb. 2014, pp. 269–74. Pubmed, doi:10.1001/jamainternmed.2013.12738.
Patz EF, Pinsky P, Gatsonis C, Sicks JD, Kramer BS, Tammemägi MC, Chiles C, Black WC, Aberle DR, NLST Overdiagnosis Manuscript Writing Team. Overdiagnosis in low-dose computed tomography screening for lung cancer. JAMA Intern Med. 2014 Feb 1;174(2):269–274.

Published In

JAMA Intern Med

DOI

EISSN

2168-6114

Publication Date

February 1, 2014

Volume

174

Issue

2

Start / End Page

269 / 274

Location

United States

Related Subject Headings

  • United States
  • Tomography, X-Ray Computed
  • Time Factors
  • Survival Rate
  • Reproducibility of Results
  • Prospective Studies
  • Probability
  • Middle Aged
  • Mass Screening
  • Male