Summary of findings 1. Low‐dose computed tomography (LDCT) screening compared to no LDCT screening for lung cancer‐related mortality.
| Low‐dose computed tomography (LDCT) screening compared to no LDCT screening for lung cancer‐related mortality | |||||
| Patient or population: healthy adults Setting: hospitals or screening centres Intervention: LDCT screening Comparison: no LDCT screening | |||||
| Outcomes | № of participants (trials) follow‐up | Certainty of the evidence (GRADE) | Relative effect (95% CI) | Anticipated absolute effects*(95% CI) | |
| Risk with no screening | Risk difference | ||||
| Lung cancer‐related mortality ‐ planned time points Follow‐up: 6 years to 10 years from randomisation | 91,122 (8 RCTs) | ⊕⊕⊕⊝ Moderatea |
RR 0.79 (0.72 to 0.87) |
Trial population | |
| 21 per 1000 | 4 fewer per 1000 people screened (3 fewer to 6 fewer) | ||||
|
All‐cause mortality ‐ planned time points Follow‐up: 6 years to 10 years from randomisation |
91,107 (8 RCTs) |
⊕⊕⊕⊝ Moderatea |
RR 0.95 (0.91 to 0.99) |
Trial population | |
| 89 per 1000 | 4 fewer per 1000 people screened (1 fewer to 8 fewer) | ||||
|
Overdiagnosis Time point: ≥ 10 years from randomisation excluding CXR trials |
28,656 (5 RCTs) | ⊕⊕⊝⊝ Lowa,c |
RD 0.18 (‐0.00 to 0.36) |
Trial population | |
| 180 more lung cancers overdiagnosed per 1000 lung cancers detected (0 more to 360 more) | |||||
|
Number of invasive tests Time point: 3 years to 10 years from randomisation |
60,003 (3 RCTs) | ⊕⊕⊕⊝ Moderatea | RR2.60 (2.41 to 2.80) | Trial population | |
| 31 per 1000 | 49 more per 1000 people screened (45 more to 55 more) | ||||
|
Any death postsurgery Time point: 6 years to 9 years from randomisation |
409 (2 RCTs) | ⊕⊕⊕⊝ Moderatea | RR 0.68 (0.24 to 1.94) | Trial population | |
| 48 per 1000 | 15 fewer per 1000 people screened (37 fewer to 45 more) | ||||
|
Health‐related quality of life ‐ anxiety Time point: 10 months to 5 years from randomisation Measured by different scales |
8153 (3 RCT) |
⊕⊕⊝⊝ Lowa,b |
SMD ‐0.43 (‐0.59 to ‐0.27) |
Trial population | |
|
SMD 0.43 lower (0.27 to 0.59 lower ) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; CXR: chest x‐ray; OR: odds ratio; RCT: randomised controlled trial; RR: risk ratio; RD: risk difference, SMD: standardised mean difference | |||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | |||||
aDowngraded one level due to high risk of "other bias" in Becker 2020, De Koning 2020, Infante 2015, and Pastorino 2012. bDowngraded one level due to indirectness: only a subset of the trial population were included for quality assessment. cDowngraded one level due to heterogeneity.