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Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening Scenarios

Lung cancer is a severe disease that affects predominantly smokers and represents a leading cause of cancer death in Europe. Recent meta-analyses of randomized controlled trials (RCTs) have yielded that low-dose computed tomography (LDCT) screening can significantly reduce lung cancer mortality in h...

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Autores principales: Nekolla, Elke A., Brix, Gunnar, Griebel, Jürgen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8870982/
https://www.ncbi.nlm.nih.gov/pubmed/35204455
http://dx.doi.org/10.3390/diagnostics12020364
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author Nekolla, Elke A.
Brix, Gunnar
Griebel, Jürgen
author_facet Nekolla, Elke A.
Brix, Gunnar
Griebel, Jürgen
author_sort Nekolla, Elke A.
collection PubMed
description Lung cancer is a severe disease that affects predominantly smokers and represents a leading cause of cancer death in Europe. Recent meta-analyses of randomized controlled trials (RCTs) have yielded that low-dose computed tomography (LDCT) screening can significantly reduce lung cancer mortality in heavy smokers or ex-smokers by about 20% compared to a control group of persons who did not receive LDCT. This benefit must be weighed against adverse health effects associated with LDCT lung screening, in particular radiation risks. For this purpose, representative organ doses were determined for a volume CT dose index of 1 mGy that can be achieved on modern devices. Using these values, radiation risks were estimated for different screening scenarios by means of sex-, organ-, and age-dependent radio-epidemiologic models. In particular, the approach was adjusted to a Western European population. For an annual LDCT screening of (ex-)smokers aged between 50 and 75 years, the estimated radiation-related lifetime attributable risk to develop cancer is below 0.25% for women and about 0.1% for men. Assuming a mortality reduction of about 20% and taking only radiation risks into account, this screening scenario results in a benefit–risk ratio of about 10 for women and about 25 for men. These benefit–risk ratio estimates are based on the results of RCTs of the highest evidence level. To ensure that the benefit outweighs the radiation risk even in standard healthcare, strict conditions and requirements must be established for the entire screening process to achieve a quality level at least as high as that of the considered RCTs.
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spelling pubmed-88709822022-02-25 Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening Scenarios Nekolla, Elke A. Brix, Gunnar Griebel, Jürgen Diagnostics (Basel) Article Lung cancer is a severe disease that affects predominantly smokers and represents a leading cause of cancer death in Europe. Recent meta-analyses of randomized controlled trials (RCTs) have yielded that low-dose computed tomography (LDCT) screening can significantly reduce lung cancer mortality in heavy smokers or ex-smokers by about 20% compared to a control group of persons who did not receive LDCT. This benefit must be weighed against adverse health effects associated with LDCT lung screening, in particular radiation risks. For this purpose, representative organ doses were determined for a volume CT dose index of 1 mGy that can be achieved on modern devices. Using these values, radiation risks were estimated for different screening scenarios by means of sex-, organ-, and age-dependent radio-epidemiologic models. In particular, the approach was adjusted to a Western European population. For an annual LDCT screening of (ex-)smokers aged between 50 and 75 years, the estimated radiation-related lifetime attributable risk to develop cancer is below 0.25% for women and about 0.1% for men. Assuming a mortality reduction of about 20% and taking only radiation risks into account, this screening scenario results in a benefit–risk ratio of about 10 for women and about 25 for men. These benefit–risk ratio estimates are based on the results of RCTs of the highest evidence level. To ensure that the benefit outweighs the radiation risk even in standard healthcare, strict conditions and requirements must be established for the entire screening process to achieve a quality level at least as high as that of the considered RCTs. MDPI 2022-02-01 /pmc/articles/PMC8870982/ /pubmed/35204455 http://dx.doi.org/10.3390/diagnostics12020364 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Nekolla, Elke A.
Brix, Gunnar
Griebel, Jürgen
Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening Scenarios
title Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening Scenarios
title_full Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening Scenarios
title_fullStr Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening Scenarios
title_full_unstemmed Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening Scenarios
title_short Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit–Risk Assessment for Different Screening Scenarios
title_sort lung cancer screening with low-dose ct: radiation risk and benefit–risk assessment for different screening scenarios
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8870982/
https://www.ncbi.nlm.nih.gov/pubmed/35204455
http://dx.doi.org/10.3390/diagnostics12020364
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