title: Low-dose computed tomography screening for lung cancer in populations highly exposed to tobacco: A systematic methodological appraisal of published randomised controlled trials.
abstract: Low-dose computed tomography (LDCT) screening recommendations for lung cancer are contradictory. The French National Authority for Health commissioned experts to carry a systematic review on the effectiveness, acceptability and safety of lung cancer screening with LDCT in subjects highly exposed to tobacco. We used MEDLINE and Embase databases (2003-2014) and identified 83 publications representing ten randomised control trials. Control arms and methodology varied considerably, precluding a full comparison and questioning reproducibility of the findings. From five trials reporting mortality results, only the National Lung Screening Trial found a significant decrease of disease-specific and all-cause mortality with LDCT screening compared to chest X-ray screening. None of the studies provided all information needed to document the risk-benefit balance. The lack of statistical power and the methodological heterogeneity of European trials question on the possibility of obtaining valid results separately or by pooling. We conclude, in regard to the lack of strong scientific evidence, that LDCT screening should not be recommended in subjects highly exposed to tobacco.
authors.affiliation: Univ. Bordeaux, ISPED, Centre INSERM U1229-Bordeaux Population Health, F-33000 Bordeaux, France; INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France; CHU de Bordeaux, Pole de sante publique, Service d'information medicale, F-33000 Bordeaux, France. Electronic address: gaelle.coureau@isped.u-bordeaux2.fr.
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Coureau
authors.affiliation: Univ. Bordeaux, ISPED, Centre INSERM U1229-Bordeaux Population Health, F-33000 Bordeaux, France; INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France; CHU de Bordeaux, Pole de sante publique, Service d'information medicale, F-33000 Bordeaux, France. Electronic address: Rachid.Salmi@isped.u-bordeaux2.fr.
authors.forename: L Rachid
authors.initials: LR
authors.lastname: Salmi
authors.affiliation: Institut de Radioprotection et de Sûreté Nucléaire, F-92260 Fontenay-aux-Roses, France. Electronic address: cecile.etard@irsn.fr.
authors.forename: Cécile
authors.initials: C
authors.lastname: Etard
authors.affiliation: Fondation JBD-Prevention-Cancer, F-91640 Fontenay les Bris, France. Electronic address: Helene.Sancho-Garnier@icm.unicancer.fr.
authors.forename: Hélène
authors.initials: H
authors.lastname: Sancho-Garnier
authors.affiliation: Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, F-69372 Lyon Cedex 08, France. Electronic address: SauvagetC@iarc.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sauvaget
authors.affiliation: Univ. Bordeaux, ISPED, Centre INSERM U1229-Bordeaux Population Health, F-33000 Bordeaux, France; INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000 Bordeaux, France; Institut Bergonié, Unité de recherche et d'épidémiologie cliniques, Inserm CIC1401, F-33076 Bordeaux Cedex, France. Electronic address: S.Mathoulin@bordeaux.unicancer.fr.
authors.forename: Simone
authors.initials: S
authors.lastname: Mathoulin-Pélissier
mesh_terms: D055088:Early Detection of Cancer / Q000379:methods; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D008403:Mass Screening / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Low-dose computed tomography; Lung cancer; Mass screening; Mortality; Tobacco