Pacheco Pedro, Melo Vanda, Martins Cátia, Ribeiro Helena
Family Health Unit New Directions, Unidade Local de Saúde do Alto Ave, Vizela, PRT.
Cureus. 2024 Dec 11;16(12):e75515. doi: 10.7759/cureus.75515. eCollection 2024 Dec.
Lung cancer is highly prevalent worldwide and is the leading cause of cancer-related death in Portugal. There is increasing evidence that low-dose computed tomography (LDCT) screening reduces mortality; however, few countries have implemented screening strategies. This review aims to gather the best evidence to assess the relevance of implementing lung cancer screening. A search was conducted for clinical practice guidelines (CPGs), systematic reviews (SRs), and meta-analyses (MAs) published between January 1, 2010, and January 31, 2024, as well as randomized controlled trials (RCTs) published between January 1, 2019, and January 31, 2024, indexed in databases such as the National Guideline Clearinghouse, Cochrane Library, Guideline Finder, Canadian Medical Association, Evidence-Based Medicine Online, Database of Abstracts of Reviews of Effectiveness (DARE), and PubMed. The MeSH terms used were "lung cancer" and "screening". To evaluate the level of evidence (LE) and strength of recommendation (SR) in the included MAs, the Strength of Recommendation Taxonomy (SORT) from the American Academy of Family Physicians was applied. A total of 460 articles were found, with two CPGs, six MAs, two SRs, and one RCT being selected. The CPGs recommend screening with LDCT for smokers with a smoking history of more than 20 pack-years, aged between 50 and 80 years. All MAs show statistically significant evidence of reduced mortality in screened patients, although without a reduction in all-cause mortality. However, there was some heterogeneity regarding the age of the target population and the screening follow-up period. Overdiagnosis rates varied between MAs. The SRs and RCT also demonstrated a reduction in lung cancer mortality, but not in all-cause mortality. LDCT lung cancer screening shows a reduction in disease-related mortality, suggesting that the implementation of organized screening for at-risk populations could have a significant positive impact. Some uncertainties remain regarding the best strategy for implementing organized screening programs.
肺癌在全球范围内高度流行，是葡萄牙癌症相关死亡的主要原因。越来越多的证据表明，低剂量计算机断层扫描（LDCT）筛查可降低死亡率；然而，很少有国家实施筛查策略。本综述旨在收集最佳证据，以评估实施肺癌筛查的相关性。检索了2010年1月1日至2024年1月31日期间发表的临床实践指南（CPG）、系统评价（SR）和荟萃分析（MA），以及2019年1月1日至2024年1月31日期间发表的随机对照试验（RCT），这些文献被收录在国家指南交换中心、考克兰图书馆、指南查找器、加拿大医学协会、循证医学在线、效果评价文摘数据库（DARE）和PubMed等数据库中。使用的医学主题词为“肺癌”和“筛查”。为了评估纳入的荟萃分析中的证据水平（LE）和推荐强度（SR），应用了美国家庭医生学会的推荐强度分类法（SORT）。共找到460篇文章，选择了两篇临床实践指南、六篇荟萃分析、两篇系统评价和一项随机对照试验。临床实践指南建议对吸烟史超过20包年、年龄在50至80岁之间的吸烟者进行LDCT筛查。所有荟萃分析均显示，筛查患者的死亡率有统计学意义的降低，尽管全因死亡率没有降低。然而，在目标人群年龄和筛查随访期方面存在一些异质性。不同荟萃分析的过度诊断率有所不同。系统评价和随机对照试验也显示肺癌死亡率降低，但全因死亡率未降低。LDCT肺癌筛查显示疾病相关死亡率降低，这表明对高危人群实施有组织的筛查可能会产生重大的积极影响。关于实施有组织筛查计划的最佳策略仍存在一些不确定性。
