Screening for lung cancer: A systematic review and meta-analysis
A partir d'une revue systématique de la littérature publiée jusqu'en mars 2015 (34 études), cette méta-analyse évalue les bénéfices, en termes de réduction de la mortalité par cancer du poumon, et les risques associés à un examen de dépistage par radiographie thoracique, avec ou sans cytologie d'expectoration, ou par tomographie numérique à faible dose de rayonnements chez les adultes présentant un risque élevé de développer la maladie
Objectives : 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).
Methods : 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.
Results : 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 6.5 years, 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.
Conclusion : 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.
Preventive Medicine , résumé, 2015