Journal Article

DKFZ-2020-01904

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Overdiagnosis in lung cancer screening - estimates from the German Lung Cancer Screening Intervention Trial.

Gonzalez Maldonado, S. (First author)DKFZ* ; Motsch, E.DKFZ* ; Trotter, A.DKFZ* ; Kauczor, H.-U. ; Heussel, C.-P. ; Hermann, S.DKFZ* ; Zeissig, S. R. ; Delorme, S.DKFZ* ; Kaaks, R. (Last author)DKFZ*

2021
Wiley-Liss Bognor Regis

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Please use a persistent id in citations: doi:10.1002/ijc.33295  doi:doi: 10.1002/ijc.33295

Abstract: Overdiagnosis is a major potential harm of lung cancer screening; knowing its potential magnitude helps to optimize screening eligibility criteria. The German Lung Screening Intervention Trial ('LUSI') is a randomized trial among 4052 long-term smokers (2622 men), 50.3-71.9 years of age from the general population around Heidelberg, Germany, comparing five annual rounds of low-dose computed tomography (n=2029) with a control arm without intervention (n=2023). After a median follow-up of 9.77 years post-randomization and 5.73 years since last screening, 74 participants were diagnosed with lung cancer in the control arm and 90 in the screening arm: 69 during the active screening period; of which 63 screen-detected and 6 interval cancers. The excess cumulative incidence in the screening arm (N=16) represented 25.4% [95%CI -11.3, 64.3] of screen-detected cancer cases (N=63). Analyzed by histologic subtype, excess incidence in the screening arm appeared largely driven by adenocarcinomas. Statistical modeling yielded an estimated mean pre-clinical sojourn time (MPST) of 5.38 [4.76, 5.88] years and a screen-test sensitivity of 81.6 [74.4%, 88.8%] for lung cancer overall, all histologic subtypes combined. Based on modeling, we further estimated that about 48% (47.5% [43.2%, 50.7%]) of screen-detected tumors have a lead time ≥4 years, whereas about 33% (32.8% [28.4%, 36.1%]) have a lead time ≥6 years, 23% (22,6% [18,6%, 25,7%]) ≥8 years, 16% (15.6% [12,2%, 18,3%]) ≥10 years and 11% (10,7% [8,0%, 13,0%]) ≥12 years. The high proportions of tumors with relatively long lead times suggests a major risk of overdiagnosis for individuals with comparatively short remaining life expectancies. This article is protected by copyright. All rights reserved.

Note: #EA:C020#LA:C020#2021 Mar 1;148(5):1097-1105 / https://doi.org/10.1002/ijc.33295

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Contributing Institute(s):

1. C020 Epidemiologie von Krebs (C020)
2. M110 Epidemiologisches Krebsregister BW (M110)
3. E010 Radiologie (E010)

Research Program(s):

1. 313 - Krebsrisikofaktoren und Prävention (POF4-313) (POF4-313)

Appears in the scientific report 2021

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Database coverage:
; BIOSIS Previews ; Biological Abstracts ; Clarivate Analytics Master Journal List ; Current Contents - Life Sciences ; DEAL Wiley ; Essential Science Indicators ; IF < 5 ; JCR ; NCBI Molecular Biology Database ; Nationallizenz ; SCOPUS ; Science Citation Index ; Science Citation Index Expanded ; Web of Science Core Collection

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