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Lung cancer is the leading cause of death among all cancers and is the third most common cancer in both men and women. This systematic review of randomized controlled trials was to determine whether the clinical trial data is for or against lung cancer screening. We searched PubMed database to find randomized controlled trials and controlled clinical trials within the last fourteen years to find studies which looked at how low dose computed-tomography (LDCT) screening affects lung cancer mortality. We included eight trials in this review of which seven were statistically lower powered studies and found no significant decrease in mortality in patients with lung cancer when using low-dose CT. However, the national lung screening trial (NLST) published in 2011 with 53,454 participants found a significant decrease in death from lung cancer when screened with low-dose CT compared with chest x-ray screening. However, we await results from the NELSON trial to further strengthen this conclusion. There are also other factors which need to be taken into account when electing to undergo screening such as, cost-effectiveness, psychological consequences, radiation exposure and unnecessary invasive procedures.
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1. Humphrey LL, Deffebach M, Pappas M, Baumann C, Artis K, Mitchell JP, et al. Screening for lung cancer with low-dose computed tomography: a systematic review to update the US Preventive services task force recommendation. Ann Intern Med. 2013;159: 411–420.
2. Manser R, Lethaby A, Irving LB, Stone C, Byrnes G, Abramson MJ, et al. Screening for lung cancer. Cochrane Database Syst Rev. 2013; CD001991.
3. Flieder DB, Port JL, Korst RJ, Christos PJ, Levin MA, Becker DE, et al. Tumor Size Is a Determinant of Stage Distribution in T1 Non-Small Cell Lung Cancer. Chest. 2005;128: 2304–2308.
4. Henschke CI, for the International Early Lung Cancer Action Program Investigators. Survival of Patients with Clinical Stage I Lung Cancer Diagnosed by Computed Tomography Screening for Lung Cancer. Clin Cancer Res. 2007;13: 4949–4950.
5. Gohagan JK, Marcus PM, Fagerstrom RM, Pinsky PF, Kramer BS, Prorok PC, et al. Final results of the Lung Screening Study, a randomized feasibility study of spiral CT versus chest X-ray screening for lung cancer. Lung Cancer. 2005;47: 9–15.
6. Pastorino U, Rossi M, Rosato V, Marchianò A, Sverzellati N, Morosi C, et al. Annual or biennial CT screening versus observation in heavy smokers: 5-year results of the MILD trial. Eur J Cancer Prev. 2012;21: 308–315.
7. Pastorino U, Rossi M, Rosato V, Marchianò A, Sverzellati N, Morosi C, et al. Annual or biennial CT screening versus observation in heavy smokers. Eur J Cancer Prev. 2012;21: 308–315.
8. Pegna AL, Picozzi G, Falaschi F, Carrozzi L, Falchini M, Carozzi FM, et al. Four-Year Results of Low-Dose CT Screening and Nodule Management in the ITALUNG Trial. J Thorac Oncol. 2013;8: 866–875.
9. Infante M, Cavuto S, Lutman FR, Passera E, Chiarenza M, Chiesa G, et al. Long-Term Follow-up Results of the DANTE Trial, a Randomized Study of Lung Cancer Screening with Spiral Computed Tomography. Am J Respir Crit Care Med. 2015;191: 1166–1175.
10. Blanchon T, Bréchot J-M, Grenier PA, Ferretti GR, Lemarié E, Milleron B, et al. Baseline results of the Depiscan study: a French randomized pilot trial of lung cancer screening comparing low dose CT scan (LDCT) and chest X-ray (CXR). Lung Cancer. 2007;58: 50–58.
11. National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365: 395–409.
12. The National Lung Screening Trial Research Team. Results of Initial Low-Dose Computed Tomographic Screening for Lung Cancer. N Engl J Med. 2013;368: 1980–1991.
13. Wille MMW, Dirksen A, Ashraf H, Saghir Z, Bach KS, Brodersen J, et al. Results of the Randomized Danish Lung Cancer Screening Trial with Focus on High-Risk Profiling. Am J Respir Crit Care Med. 2016;193: 542–551.
14. Field JK, Duffy SW, Baldwin DR, Whynes DK, Devaraj A, Brain KE, et al. UK Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening. Thorax. 2016;71: 161–170.
15. Ten Haaf K, van Rosmalen J, de Koning HJ. Lung cancer detectability by test, histology, stage, and gender: estimates from the NLST and the PLCO trials. Cancer Epidemiol Biomarkers Prev. 2015;24: 154–161.
16. Oken MM, Hocking WG, Kvale PA, Andriole GL, Buys SS, Church TR, et al. Screening by chest radiograph and lung cancer mortality: the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized trial. JAMA. 2011;306: 1865–1873.
17. Marcus PM, Bergstralh EJ, Zweig MH, Harris A, Offord KP, Fontana RS. Extended lung cancer incidence follow-up in the Mayo Lung Project and overdiagnosis. J Natl Cancer Inst. 2006;98: 748–756.
18. Black WC. Overdiagnosis: An underrecognized cause of confusion and harm in cancer screening. J Natl Cancer Inst. 2000;92: 1280–1282.
19. van Klaveren RJ, Habbema JDF, Pedersen JH, de Koning HJ, Oudkerk M, Hoogsteden HC. Lung cancer screening by low-dose spiral computed tomography. Eur Respir J. 2001;18: 857–866.
20. Smith RA, Manassaram-Baptiste D, Brooks D, Doroshenk M, Fedewa S, Saslow D, et al. Cancer screening in the United States, 2015: a review of current American cancer society guidelines and current issues in cancer screening. CA Cancer J Clin. 2015;65: 30–54.
21. Ru Zhao Y, Zhao YR, Xie X, de Koning HJ, Mali WP, Vliegenthart R, et al. NELSON lung cancer screening study. Cancer Imaging. 2011;11: S79–S84.
22. Rasmussen JF, Siersma V, Pedersen JH, Brodersen J. Psychosocial consequences in the Danish randomised controlled lung cancer screening trial (DLCST). Lung Cancer. 2015;87: 65–72.
23. van der Aalst CM, Ten Haaf K, de Koning HJ. Lung cancer screening: latest developments and unanswered questions. Lancet Respir Med. 2016;4: 749–761.
24. Black WC, Gareen IF, Soneji SS, Sicks JD, Keeler EB, Aberle DR, et al. Cost-effectiveness of CT screening in the National Lung Screening Trial. N Engl J Med. 2014;371: 1793–1802.
25. van der Aalst CM, van den Bergh KAM, Willemsen MC, de Koning HJ, van Klaveren RJ. Lung cancer screening and smoking abstinence: 2 year follow-up data from the Dutch-Belgian randomised controlled lung cancer screening trial. Thorax. 2010;65: 600–605.
26. Ashraf H, Saghir Z, Dirksen A, Pedersen JH, Thomsen LH, Døssing M, et al. Smoking habits in the randomised Danish Lung Cancer Screening Trial with low-dose CT: final results after a 5-year screening programme. Thorax. 2014;69: 574–579.
27. Pedersen JH, Tønnesen P, Ashraf H. Smoking cessation and lung cancer screening. Ann Transl Med. 2016;4: 157.
28. Smoking cessation after early diagnosis can be beneficial. Nurs Stand. 2010;24: 18.