• Department of Respiratory Diseases, Henan Key Laboratory of Chinese Medicine for Respiratory Disease, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China; Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases co-construction by Henan province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China.
• Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China.
• Center for Health Economics, University of York, York, United Kingdom.
• Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University.
• Department of Respiratory Diseases, Henan Key Laboratory of Chinese Medicine for Respiratory Disease, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China; Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases co-construction by Henan province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China. Electronic address: Li_js8@163.com.
• Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China. Electronic address: lcxjtu@xjtu.edu.cn.
• Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool L3 5QA; Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases co-construction by Henan province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China. Electronic address: Tao.chen@lstmed.ac.uk.

BACKGROUND: Increasing evidence supports lung cancer screening with low-dose computed tomography (LDCT). However, the benefits of LDCT screening for lung cancer may not be immediate, making it unlikely to benefit patients with limited life expectancy.

RESEARCH QUESTION: What is the time to benefit (TTB) from LDCT screening for individuals at high risk for lung cancer?

STUDY DESIGN AND METHODS: Population-based, randomized controlled trials of lung cancer screening using LDCT and reporting mortality outcomes were systematically searched in PubMed. TTB was estimated for the National Lung Screening Trial (NLST) and the pooled data from four trials using our established analysis framework.

RESULTS: Our analysis included four trials encompassing 64,105 individuals. In the NLST trial(N=53,452), to prevent one death from lung cancer, 2,000 individuals would need to be screened over 1.78(95% confidence interval, 0.60-5.27) years. On average, it took 2.87 (1.31- 6.32), 4.66 (2.64-8.21) and 8.87 (5.12-15.37) years before one death from lung cancer was prevented for every 1000, 500 and 200 individuals screened, respectively. These findings didn't vary when added to other trials.

INTERPRETATION: The clinical benefits of LDCT screening may not be appropriate for individuals with limited life expectancy. Integrating TTB estimates into patient selection criteria could help maximise the benefits of LDCT screening.