Benefits and harms of computed tomography lung cancer screening strategies: A comparative modeling study for the U.S. Preventive services task force

Harry J. De Koning*, Rafael Meza, Sylvia K. Plevritis, Kevin Ten Haaf, Vidit N. Munshi, Jihyoun Jeon, Saadet Ayca Erdogan, Chung Yin Kong, Summer S. Han, Joost Van Rosmalen, Sung Eun Choi, Paul F. Pinsky, Amy Berrington De Gonzalez, Christine D. Berg, William C. Black, Martin C. Tammemagi, William D. Hazelton, Eric J. Feuer, Pamela M. McMahon

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

347 Citations (Scopus)


Background: The optimum screening policy for lung cancer is unknown. Objective: To identify efficient computed tomography (CT) screening scenarios in which relatively more lung cancer deaths are averted for fewer CT screening examinations. Design: Comparative modeling study using 5 independent models. Data Sources: The National Lung Screening Trial; the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial; the Surveillance, Epidemiology, and End Results program; and the U.S. Smoking History Generator. Target Population: U.S. cohort born in 1950. Time Horizon: Cohort followed from ages 45 to 90 years. Perspective: Societal. Intervention: 576 scenarios with varying eligibility criteria (age, pack-years of smoking, years since quitting) and screening intervals. Outcome Measures: Benefits included lung cancer deaths averted or life-years gained. Harms included CT examinations, false-positive results (including those obtained from biopsy/surgery), overdiagnosed cases, and radiation-related deaths. Results of Best-Case Scenario: The most advantageous strategy was annual screening from ages 55 through 80 years for eversmokers with a smoking history of at least 30 pack-years and ex-smokers with less than 15 years since quitting. It would lead to 50% (model ranges, 45% to 54%) of cases of cancer being detected at an early stage (stage I/II), 575 screening examinations per lung cancer death averted, a 14% (range, 8.2% to 23.5%) reduction in lung cancer mortality, 497 lung cancer deaths averted, and 5250 life-years gained per the 100 000-member cohort. Harms would include 67 550 false-positive test results, 910 biopsies or surgeries for benign lesions, and 190 overdiagnosed cases of cancer (3.7% of all cases of lung cancer [model ranges, 1.4% to 8.3%]). Results of Sensitivity Analysis: The number of cancer deaths averted for the scenario varied across models between 177 and 862; the number of overdiagnosed cases of cancer varied between 72 and 426. Limitations: Scenarios assumed 100% screening adherence. Data derived from trials with short duration were extrapolated to lifetime follow-up. Conclusion: Annual CT screening for lung cancer has a favorable benefit-harm ratio for individuals aged 55 through 80 years with 30 or more pack-years' exposure to smoking.

Original languageEnglish
Pages (from-to)311-320
Number of pages10
JournalAnnals of Internal Medicine
Issue number5
Publication statusPublished - 4 Mar 2014

Bibliographical note

Funding Information:
This report is based on research conducted by the National Cancer Institute's Cancer Intervention and Surveillance Modeling Network through support from an interagency agreement with the Agency for Healthcare Research and Quality, Rockville, Maryland (administrative supplement to U01 CA152956).


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