Pahwa Manisha, Cernat Alexandra, Abelson Julia, Demers Paul A, Schwartz Lisa, Shen Katrina, Chowdhury Mehreen, Higgins Caroline, Vanstone Meredith
PhD Candidate, Health Policy PhD Program, Department of Health Research Methods, Evidence and Impact, McMaster University, Canada.
Professor, Department of Health Research Methods, Evidence and Impact, McMaster University, Canada.
J Health Serv Res Policy. 2025 Jul;30(3):198-207. doi: 10.1177/13558196241288984. Epub 2024 Oct 15.
ObjectiveScreening for lung cancer with low dose computed tomography aims to reduce lung cancer mortality, but there is a lack of knowledge about how target populations consider its potential benefits and harms.MethodsWe conducted a systematic review of primary empirical studies published in any jurisdiction since 2002 using an integrative meta-synthesis technique. We searched six health and social science databases. Two reviewers independently screened titles, abstracts, and potentially eligible full-text studies. Quantitative assessments and open-ended perspectives on benefits and harms were extracted and convergently integrated at analysis using a narrative approach. Study quality was assessed.ResultsThe review included 26 quantitative, 18 qualitative, and 5 mixed methods studies. Study quality was acceptable. Lung cancer screening was widely perceived to be personally beneficial for early detection and reassurance. Radiation exposure and screening accuracy were recognised as harms, but these were frequently considered to be justified by early detection of lung cancer. Stigma, anxiety, and fear related to screening procedures and results were pervasive among current smokers. People with low incomes reported not participating in screening because of potential out-of-pocket costs and geographic access.ConclusionsPopulations targeted for lung cancer screening tended to consider screening as personally beneficial and rationalised physical, but not psychological, harms. Screening programmes should be clear about benefits, use non-stigmatising design, and consider equity as a guiding principle.
采用低剂量计算机断层扫描筛查肺癌旨在降低肺癌死亡率，但对于目标人群如何看待其潜在益处和危害，目前仍缺乏了解。
我们运用整合性元分析技术，对自2002年以来在任何司法管辖区发表的原发性实证研究进行了系统综述。我们检索了六个健康与社会科学数据库。两名评审员独立筛选标题、摘要及可能符合条件的全文研究。提取了关于益处和危害的定量评估及开放式观点，并在分析时采用叙述方法进行综合整合。对研究质量进行了评估。
该综述纳入了26项定量研究、18项定性研究和5项混合方法研究。研究质量尚可。肺癌筛查被广泛认为对个人有益，有助于早期发现和安心。辐射暴露和筛查准确性被视为危害，但人们常认为这些危害因肺癌的早期发现而合理。当前吸烟者中普遍存在与筛查程序和结果相关的耻辱感、焦虑和恐惧。低收入人群表示因潜在的自付费用和地理可达性问题而未参与筛查。
肺癌筛查的目标人群倾向于认为筛查对个人有益，并将身体上而非心理上的危害合理化。筛查项目应明确益处，采用无耻辱感的设计，并将公平作为指导原则。
