Evidence of Benefit Associated With Screening

Screening by low-dose helical computed tomography

There is evidence that screening persons aged 55 to 74 years who have cigarette smoking histories of 30 or more pack-years and who, if they are former smokers, have quit within the last 15 years reduces lung cancer mortality by 20% and all-cause mortality by 6.7%.

Magnitude of Effect: 16% relative reduction in lung cancer–specific mortality.

Study Design: Evidence obtained from a randomized controlled trial.

Internal Validity: Good.

Consistency: Not applicable (N/A)—one randomized trial to date.

External Validity: Fair.

Based on solid evidence, at least 98% of all positive low-dose helical computed tomography screening exams (but not all) do not result in a lung cancer diagnosis. False-positive exams may result in unnecessary invasive diagnostic procedures.

Magnitude of Effect: Large.

Study Design: Evidence obtained from a randomized controlled trial.

Internal Validity: Good.

Consistency: Good.

External Validity: Fair.

Evidence of No Benefit Associated With Screening

Screening by chest x-ray and/or sputum cytology

Based on solid evidence, screening with chest x-ray and/or sputum cytology does not reduce mortality from lung cancer in the general population or in ever-smokers.

Magnitude of Effect: N/A.

Study Design: Randomized controlled trials.

Internal Validity: Good.

Consistency: Good.

External Validity: Good.

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