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About this Publication
Title
The influence of postscreening follow-up time and participant characteristics on estimates of overdiagnosis from lung cancer screening trials.
Pubmed ID
35809038 (View this publication on the PubMed website)
Digital Object Identifier
Publication
Int J Cancer. 2022 Nov 1; Volume 151 (Issue 9): Pages 1491-1501
Authors
Li M, Zhang L, Charvat H, Callister ME, Sasieni P, Christodoulou E, Kaaks R, Johansson M, Carvalho AL, Vaccarella S, Robbins HA
Affiliations
  • Department of Cancer Prevention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
  • International Agency for Research on Cancer, Lyon, France.
  • Leeds Teaching Hospitals, Leeds, UK.
  • Kings College London, London, UK.
  • Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
Abstract

We aimed to explore the underlying reasons that estimates of overdiagnosis vary across and within low-dose computed tomography (LDCT) lung cancer screening trials. We conducted a systematic review to identify estimates of overdiagnosis from randomised controlled trials of LDCT screening. We then analysed the association of Ps (the excess incidence of lung cancer as a proportion of screen-detected cases) with postscreening follow-up time using a linear random effects meta-regression model. Separately, we analysed annual Ps estimates from the US National Lung Screening Trial (NLST) and German Lung Cancer Screening Intervention Trial (LUSI) using exponential decay models with asymptotes. We conducted stratified analyses to investigate participant characteristics associated with Ps using the extended follow-up data from NLST. Among 12 overdiagnosis estimates from 8 trials, the postscreening follow-up ranged from 3.8 to 9.3 years, and Ps ranged from -27.0% (ITALUNG, 8.3 years follow-up) to 67.2% (DLCST, 5.0 years follow-up). Across trials, 39.1% of the variation in Ps was explained by postscreening follow-up time. The annual changes in Ps were -3.5% and -3.9% in the NLST and LUSI trials, respectively. Ps was predicted to plateau at 2.2% for NLST and 9.2% for LUSI with hypothetical infinite follow-up. In NLST, Ps increased with age from -14.9% (55-59 years) to 21.7% (70-74 years), and time trends in Ps varied by histological type. The findings suggest that differences in postscreening follow-up time partially explain variation in overdiagnosis estimates across lung cancer screening trials. Estimates of overdiagnosis should be interpreted in the context of postscreening follow-up and population characteristics.

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