title: Screening for lung cancer with low-dose computed tomography: a systematic review to update the US Preventive services task force recommendation.
abstract: BACKGROUND
  Lung cancer is the leading cause of cancer-related death in the United States. Because early-stage lung cancer is associated with lower mortality than late-stage disease, early detection and treatment may be beneficial.
  
  
  OBJECTIVE
  To update the 2004 review of screening for lung cancer for the U.S. Preventive Services Task Force, focusing on screening with low-dose computed tomography (LDCT).
  
  
  METHODS
  MEDLINE (2000 to 31 May 2013), the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2012), Scopus, and reference lists.
  
  
  METHODS
  English-language randomized, controlled trials or cohort studies that evaluated LDCT screening for lung cancer.
  
  
  METHODS
  One reviewer extracted study data about participants, design, analysis, follow-up, and results, and a second reviewer checked extractions. Two reviewers rated study quality using established criteria.
  
  
  RESULTS
  Four trials reported results of LDCT screening among patients with smoking exposure. One large good-quality trial reported that screening was associated with significant reductions in lung cancer (20%) and all-cause (6.7%) mortality. Three small European trials showed no benefit of screening. Harms included radiation exposure, overdiagnosis, and a high rate of false-positive findings that typically were resolved with further imaging. Smoking cessation was not affected. Incidental findings were common.
  
  
  CONCLUSIONS
  Three trials were underpowered and of insufficient duration to evaluate screening effectiveness. Overdiagnosis, an important harm of screening, is of uncertain magnitude. No studies reported results in women or minority populations.
  
  
  CONCLUSIONS
  Strong evidence shows that LDCT screening can reduce lung cancer and all-cause mortality. The harms associated with screening must be balanced with the benefits.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.affiliation: From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, and Portland Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Humphrey
authors.affiliation: From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, and Portland Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Mark
authors.initials: M
authors.lastname: Deffebach
authors.affiliation: From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, and Portland Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Miranda
authors.initials: M
authors.lastname: Pappas
authors.affiliation: From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, and Portland Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Christina
authors.initials: C
authors.lastname: Baumann
authors.affiliation: From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, and Portland Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Artis
authors.affiliation: From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, and Portland Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Jennifer Priest
authors.initials: JP
authors.lastname: Mitchell
authors.affiliation: From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, and Portland Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Zakher
authors.affiliation: From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, and Portland Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Rongwei
authors.initials: R
authors.lastname: Fu
authors.affiliation: From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, and Portland Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Slatore
mesh_terms: D055088:Early Detection of Cancer; D019317:Evidence-Based Medicine; D005189:False Positive Reactions; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality; D008403:Mass Screening / Q000009:adverse effects* / Q000379:methods* / Q000523:psychology; D011829:Radiation Dosage; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects; D014057:Tomography, X-Ray Computed / Q000009:adverse effects* / Q000379:methods* / Q000523:psychology