Journal Article

Screening for lung cancer: A systematic review of overdiagnosis and its implications

Fernández‐Sáenz, Fiorella Karina, Carvalho, Andre L, van der Aalst, Carlijn, Ritchie, David, Espina, Carolina, Thorat, Mangesh, Pissinis, Moira Magdalena, Solà, Ivan, Pinto, Ana Carolina Pereira Nunes, Baldwin, David R, de la Torre‐Perez, Laura, Alonso‐Coello, Pablo, Canelo‐Aybar, Carlos

2025

Overview

Low‐dose computed tomography (LDCT) screening is increasingly used for early lung cancer detection targeted to high‐risk populations. Quantifying overdiagnosis, its potential harms, and economic consequences is important. We assessed the magnitude, harms, and economic impact of lung cancer overdiagnosis from LDCT screening in high‐risk populations. We synthesized evidence from eight randomized trials involving 84,660 participants. LDCT may increase overdiagnosis compared to no screening (relative risk [RR] 1.05; 222 additional cases per 100 000 people screened; low certainty). Compared to chest x‐ray (CXR), LDCT likely slightly increases overdiagnosis (RR 1.01; 63 additional cases per 100 000 people screened; moderate certainty). The proportion of overdiagnosed cancers is 0.07 (7000 more lung cancers overdiagnosed per 100 000 lung cancers detected; low certainty) when compared to no screening, and 0.01 compared to CXR (1000 more lung cancers overdiagnosed per 100 000 lung cancers detected; moderate certainty). In terms of cost, LDCT resulted in an additional societal burden of €2,026,422.00 per 100 000 individuals screened compared to no screening. The magnitude of overdiagnosis in LDCT screening is likely low compared to CXR.