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Review ArticleSystematic Review

Cancer-Specific Mortality, All-Cause Mortality, and Overdiagnosis in Lung Cancer Screening Trials: A Meta-Analysis

Mark H. Ebell, Michelle Bentivegna and Cassie Hulme
The Annals of Family Medicine November 2020, 18 (6) 545-552; DOI: https://doi.org/10.1370/afm.2582
Mark H. Ebell
Department of Epidemiology, College of Public Health, University of Georgia, Athens, Georgia
MD, MS
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  • For correspondence: ebell@uga.edu
Michelle Bentivegna
Department of Epidemiology, College of Public Health, University of Georgia, Athens, Georgia
MPH
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Cassie Hulme
Department of Epidemiology, College of Public Health, University of Georgia, Athens, Georgia
MPH
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    Figure 1.

    Forest plot of lung cancer incidence for trials with 8 or more years of follow-up.

    DANTE = Detection and Screening of Early Lung Cancer With Novel Imaging Technology; DLCST = Danish Lung Cancer Screening Trial; ITALUNG = Italian Lung Cancer Screening Trial; LUSI = Lung Cancer Screening Intervention; NELSON = Nederlands–Leuvens Longkanker Screenings Onderzoek; RR = relative risk.

    Note: Weights are from random effects analysis.

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    Figure 2.

    Forest plot of lung cancer–specific mortality, sorted by shortest to longest median duration of follow-up.

    DANTE = Detection and Screening of Early Lung Cancer With Novel Imaging Technology; DLCST = Danish Lung Cancer Screening Trial; ITALUNG = Italian Lung Cancer Screening Trial; LSS = Lung Screening Study; LUSI = Lung Cancer Screening Intervention; MILD = Multicentric Italian Lung Detection; NELSON = Nederlands–Leuvens Longkanker Screenings Onderzoek; RR = relative risk.

    Note: Weights are from random effects analysis.

  • Figure 3.
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    Figure 3.

    Forest plot of all-cause mortality, sorted by shortest to longest median duration of follow-up.

    DANTE = Detection and Screening of Early Lung Cancer With Novel Imaging Technology; DLCST = Danish Lung Cancer Screening Trial; ITALUNG = Italian Lung Cancer Screening Trial; LSS = Lung Screening Study; LUSI = Lung Cancer Screening Intervention; MILD = Multicentric Italian Lung Detection; NELSON = Nederlands–Leuvens Longkanker Screenings Onderzoek; RR = relative risk.

    Note: Weights are from random effects analysis.

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    Table 1.

    Quality Assessment of the 9 Trials Meeting Inclusion Criteria

    Trial, YearRandom Sequence GenerationAllocation ConcealmentBlinding of Participants and PersonnelBlinding of Outcome AssessmentaIncomplete Outcome DataSelective Reporting
    National Lung Screening Trial Research Team et al,5 2011LLLL/ULL
    Infante et al,7 2015LULL/ULL
    Wille et al,8 2016LLLL/ULL
    Paci et al,19 2017LLLL/ULL
    Yang et al,12 2018HHLL/ULL
    Doroudi et al,20 20 1 8LULL/ULL
    Pastorino et al,21 2019LLLL/ULL
    Becker et al,18 2020LULL/ULL
    de Koning et al," 2020LULL/ULL
    • H = high risk of bias; L = low risk of bias; U = unclear risk of bias.

    • ↵a Risk of bias for all-cause mortality/risk of bias for lung cancer-specific mortality.

    • Note: Quality was assessed with the Cochrane Risk of Bias Tool.15

    • View popup
    Table 2.

    Characteristics of the 8 Trials Included in Quantitative Meta-Analyses

    Trial, YearInclusion CriteriaParticipants,No.Lung Cancer Mortality in Control Group, %Age at Study EntrySex, % MaleMedian Follow-up, YPack-Years of Smoking at EntryCurrent Smokers, %CountryScreening Years
    National Lung Screening Trial Research Team et al,5 2011Aged 55-74 years, ≥30 pack-years, current smoker or quit within last 15 years53,4541.7NR59.06.5Median: 4848United States2002-2007
    Infante et al,7 2015Aged 60-74 years, male, smoker of ≥20 pack-years or quit within 10 years2,4504.6Mean: 64.6 years100.08.35Median: 45; mean: 4757Italy2001-2012
    Wille et al,8 2016Aged 50-70 years, smoker of ≥20 pack-years or exsmoker who had quit after aged 50 years, and within 10 years4,1041.9Mean: 57.9 years55.29.8Mean: 3676Denmark2004-2008
    Paci et al,19 2017Aged 55-69 years, smoker or exsmoker (≥20 pack-years in the last 10 years) who had quit no more than 10 years ago3,2063.8Mean: 60.8 years64.78.5Median: control, 38; screening, 4066Italy2004-2014
    Doroudi et al,20 2018Aged 55-74 years, smoker of ≥30 pack-years or quit within last 10 years3,3181.6NR58.65.2Median: 5458United States2000-2001
    Pastorino et al,21 2019Aged 49-75 years, current smoker ≥20 pack-years or quit within last 10 years, no cancer in last 5 years4,0992.3Median: control, 57 years; screening, 58 years66.36.2Median: control, 38; screening, 39Control: 90 screening: 69Italy2005-2018
    Becker et al,18 2020Aged 50-69 years, ≥25 years of smoking 15 cigarettes per day, or ≥30 years of smoking 10 cigarettes per day, or exsmoker who quit no more than 10 years ago4,0522.0NR64.78.9NR62Germany2011-2018
    de Koning et al,11 2020Aged 50-74 years, male, current or former smoker (who had quit within 10 years) who smoked >15 cigarettes per day for >25 years or who smoked >10 cigarettes per day for >30 years15,7893.1Median: 58 years83.610.0Median: 3855Netherlands and Belgium2003-2015
    • NR = not reported.

Additional Files

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    Supplemental Appendix & Table

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    • Supplemental data: Appendix, Table, Figs - PDF file
  • Correction

    In the originally published article, the x-axis was labeled incorrectly and the scale was incorrect. The author regrets the error. The figure has been corrected online;  therefore, the online figure differs from the print publication.

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The Annals of Family Medicine: 18 (6)
The Annals of Family Medicine: 18 (6)
Vol. 18, Issue 6
1 Nov 2020
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Cancer-Specific Mortality, All-Cause Mortality, and Overdiagnosis in Lung Cancer Screening Trials: A Meta-Analysis
Mark H. Ebell, Michelle Bentivegna, Cassie Hulme
The Annals of Family Medicine Nov 2020, 18 (6) 545-552; DOI: 10.1370/afm.2582

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Cancer-Specific Mortality, All-Cause Mortality, and Overdiagnosis in Lung Cancer Screening Trials: A Meta-Analysis
Mark H. Ebell, Michelle Bentivegna, Cassie Hulme
The Annals of Family Medicine Nov 2020, 18 (6) 545-552; DOI: 10.1370/afm.2582
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