Preventive Health Care, 2003 Update: Screening for Lung Cancer: Updated Recommendations from the Canadian Task Force on Preventive Health Care
Prepared by V.A. Palda, MD, MSc, H.G.C. Van Spall, MD, BSc, with the Canadian Task Force on Preventive Health Care
These recommendations were finalized by the Task Force in June 2003.
| MANEUVER | EFFECTIVENESS | LEVEL OF EVIDENCE <REF> | RECOMMENDATION |
| Annual chest radiographic examination (CXR) of asymptomatic people | Pooled analysis and updates from earlier randomized trials fail to demonstrate long-term mortality reduction in screened groups. |
Cochrane systematic review of RCTs (I)7 and randomized trial updates (I)8,9 |
The recent evidence is not sufficiently strong to overturn previous negative results from randomized trials. The CTFPHC concludes that there still is fair evidence to recommend against screening asymptomatic people for lung cancer using chest radiographic examination (D). |
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Four of five case-control studies showed reduction in odds ratio (0.40-0.54) of dying from lung cancer for those screened.10-12,14 One case- control study did not find a significant benefit associated with screening (OR=0.72, 95% CI: 0.50-1.03).13 |
Case-control studies (II-2)10-14 | ||
| Spiral CT scanning (CT scan versus CXR) of asymptomatic people |
Radiologic interpretation of screen scans is excellent (kappa 0.91, 95% CI: 0.88-0.94).15 More non-calcified lung nodules were detected by CT scan than CXR.16 More cancers were detected overall by CT.16 Overall cancer detection rate of 0.40% (05% CI: 0.23%-0.57%).18 In the absence of any report about the population, significance of the detection rates are unclear.19 False-positives & false-negatives.15,17-18 |
Diagnostic studies (II-2, III)15-19 |
The CTF concludes that there is insufficient evidence (in quantity and/or quality) to make a recommendation as to whether spiral CT scanning should be used for screening asymptomatic people for lung cancer; however other factors may influence decision-making (I). |
Despite the insufficient evidence to date regarding lung cancer screening, smoking cessation should be emphasized to the patient as the preferred modality for reducing lung cancer mortality.