title: Screening for lung cancer: A systematic review and meta-analysis.
abstract: To examine evidence on benefits and harms of screening average to high-risk adults for lung cancer using chest radiology (CXR), sputum cytology (SC) and low-dose computed tomography (LDCT).
  
  
  
  This systematic review was conducted to provide up to date evidence for Canadian Task Force on Preventive Health Care (CTFPHC) lung cancer screening guidelines. Four databases were searched to March 31, 2015 along with utilizing a previous Cochrane review search. Randomized trials reporting benefits were included; any design was included for harms. Meta-analyses were performed if possible. PROSPERO #CRD42014009984.
  
  
  
  Thirty-four studies were included. For lung cancer mortality there was no benefit of CXR screening, with or without SC. Pooled results from three small trials comparing LDCT to usual care found no significant benefits for lung cancer mortality. One large high quality trial showed statistically significant reductions of 20% in lung cancer mortality over a follow-up of 6.5years, for LDCT compared with CXR. LDCT screening was associated with: overdiagnosis of 10.99-25.83%; 11.18 deaths and 52.03 patients with major complications per 1000 undergoing invasive follow-up procedures; median estimate for false positives of 25.53% for baseline/once-only screening and 23.28% for multiple rounds; and 9.74 and 5.28 individuals per 1000 screened, with benign conditions underwent minor and major invasive follow-up procedures.
  
  
  
  The evidence does not support CXR screening with or without sputum cytology for lung cancer. High quality evidence showed that in selected high-risk individuals, LDCT screening significantly reduced lung cancer mortality and all-cause mortality. However, for its implementation at a population level, the current evidence warrants the development of standardized practices for screening with LDCT and follow-up invasive testing to maximize accuracy and reduce potential associated harms.
authors.affiliation: McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario L8S 4K1, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Room HSC-2C, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada. Electronic address: aliu@mcmaster.ca.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Usman Ali
authors.affiliation: Department of Surgery, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. Electronic address: jmiller@mcmaster.ca.
authors.forename: John
authors.initials: J
authors.lastname: Miller
authors.affiliation: McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario L8S 4K1, Canada; School of Nursing, Faculty of Health Sciences, McMaster University, Health Sciences Centre Room HSC-3N25F, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. Electronic address: lpeirson@mcmaster.ca.
authors.forename: Leslea
authors.initials: L
authors.lastname: Peirson
authors.affiliation: McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario L8S 4K1, Canada; School of Nursing, Faculty of Health Sciences, McMaster University, Health Sciences Centre Room HSC-3N25F, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. Electronic address: fitzd@mcmaster.ca.
authors.forename: Donna
authors.initials: D
authors.lastname: Fitzpatrick-Lewis
authors.affiliation: McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario L8S 4K1, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Room HSC-2C, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada. Electronic address: mkenny@mcmaster.ca.
authors.forename: Meghan
authors.initials: M
authors.lastname: Kenny
authors.affiliation: McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario L8S 4K1, Canada; School of Nursing, Faculty of Health Sciences, McMaster University, Health Sciences Centre Room HSC-3N25F, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. Electronic address: dsherif@mcmaster.ca.
authors.forename: Diana
authors.initials: D
authors.lastname: Sherifali
authors.affiliation: McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario L8S 4K1, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Room HSC-2C, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada. Electronic address: praina@mcmaster.ca.
authors.forename: Parminder
authors.initials: P
authors.lastname: Raina
mesh_terms: D002170:Canada; D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D009026:Mortality / Q000639:trends; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Lung cancer; Primary health care; Screening; Systematic review