title: Benefits and harms of computed tomography lung cancer screening strategies: a comparative modeling study for the U.S. Preventive Services Task Force.
abstract: BACKGROUND
  The optimum screening policy for lung cancer is unknown.
  
  
  OBJECTIVE
  To identify efficient computed tomography (CT) screening scenarios in which relatively more lung cancer deaths are averted for fewer CT screening examinations.
  
  
  METHODS
  Comparative modeling study using 5 independent models.
  
  
  METHODS
  The National Lung Screening Trial; the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial; the Surveillance, Epidemiology, and End Results program; and the U.S. Smoking History Generator.
  
  
  METHODS
  U.S. cohort born in 1950.
  
  
  METHODS
  Cohort followed from ages 45 to 90 years.
  
  
  CONCLUSIONS
  Societal.
  
  
  METHODS
  576 scenarios with varying eligibility criteria (age, pack-years of smoking, years since quitting) and screening intervals.
  
  
  METHODS
  Benefits included lung cancer deaths averted or life-years gained. Harms included CT examinations, false-positive results (including those obtained from biopsy/surgery), overdiagnosed cases, and radiation-related deaths.
  The most advantageous strategy was annual screening from ages 55 through 80 years for ever-smokers with a smoking history of at least 30 pack-years and ex-smokers with less than 15 years since quitting. It would lead to 50% (model ranges, 45% to 54%) of cases of cancer being detected at an early stage (stage I/II), 575 screening examinations per lung cancer death averted, a 14% (range, 8.2% to 23.5%) reduction in lung cancer mortality, 497 lung cancer deaths averted, and 5250 life-years gained per the 100,000-member cohort. Harms would include 67,550 false-positive test results, 910 biopsies or surgeries for benign lesions, and 190 overdiagnosed cases of cancer (3.7% of all cases of lung cancer [model ranges, 1.4% to 8.3%]).
  
  
  RESULTS
  The number of cancer deaths averted for the scenario varied across models between 177 and 862; the number of overdiagnosed cases of cancer varied between 72 and 426.
  
  
  CONCLUSIONS
  Scenarios assumed 100% screening adherence. Data derived from trials with short duration were extrapolated to lifetime follow-up.
  
  
  CONCLUSIONS
  Annual CT screening for lung cancer has a favorable benefit-harm ratio for individuals aged 55 through 80 years with 30 or more pack-years' exposure to smoking.
  
  
  BACKGROUND
  National Cancer Institute.
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
authors.forename: Rafael
authors.initials: R
authors.lastname: Meza
authors.forename: Sylvia K
authors.initials: SK
authors.lastname: Plevritis
authors.forename: Kevin
authors.initials: K
authors.lastname: ten Haaf
authors.forename: Vidit N
authors.initials: VN
authors.lastname: Munshi
authors.forename: Jihyoun
authors.initials: J
authors.lastname: Jeon
authors.forename: Saadet Ayca
authors.initials: SA
authors.lastname: Erdogan
authors.forename: Chung Yin
authors.initials: CY
authors.lastname: Kong
authors.forename: Summer S
authors.initials: SS
authors.lastname: Han
authors.forename: Joost
authors.initials: J
authors.lastname: van Rosmalen
authors.forename: Sung Eun
authors.initials: SE
authors.lastname: Choi
authors.forename: Paul F
authors.initials: PF
authors.lastname: Pinsky
authors.forename: Amy
authors.initials: A
authors.lastname: Berrington de Gonzalez
authors.forename: Christine D
authors.initials: CD
authors.lastname: Berg
authors.forename: William C
authors.initials: WC
authors.lastname: Black
authors.forename: Martin C
authors.initials: MC
authors.lastname: Tammemägi
authors.forename: William D
authors.initials: WD
authors.lastname: Hazelton
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Feuer
authors.forename: Pamela M
authors.initials: PM
authors.lastname: McMahon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D015233:Models, Statistical; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects; D014057:Tomography, X-Ray Computed