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Lung cancer screening: adverse effects, and uncertain benefits

In 2013, to reduce lung cancer deaths, it is better to encourage non-smokers never to smoke, and to help smokers cut down or quit.

Lung cancers are the leading cause of cancer deaths in the world. Nearly 90% of lung cancer patients are smokers or former smokers.

X-ray screening of the lungs is not advisable: according to clinical trial data, it does not reduce mortality, even among smokers, but it does expose people to radiation and a high risk of false positive results, i.e. the discovery of benign nodules that will be needlessly investigated with the risk of complications.

The harm-benefit balance of screening using a low-dose computed tomography (CT) has not been sufficiently established to justify screening people with no symptoms suggestive of lung cancer. It has neither been ruled out, nor proven whether CT screening can result in a reduction in cancer mortality. But it does expose participants to both physical and psychological adverse effects, when most of them are unaffected by cancer: around 90% of anomalies detected by CT are false positives; screening carries the risk of overdiagnosis and of complications associated with invasive diagnostic procedures and repeated radiation.

It is probable that both the favourable and adverse effects of screening vary according to the population invited to be screened, and depend on the performance of the CT and of the radiologists as well as on the criteria selected to determine whether a pulmonary nodule requires further investigation.

It is preferable to wait for other results before recommending low-dose-scanner screening for lung cancer.

To reduce mortality from lung cancer, the priority is to encourage people to quit smoking.

©Prescrire 1 January 2014

"Screening for lung cancer. Too many uncertainties, even for smokers" Prescrire Int 2014; 23 (145): 19-23. (Pdf, subscribers only).
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