Critical appraisal:Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, et al 2012

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Critical Appraisal

Article being appraised

Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA 2012 Jun 13;307(22):2418-29 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22610500.


Applicable clinical question

Key Facts

Study Design

systematic review

Number of Patients:

60030


Includes an economic evaluation

no

Evidence ratings

Level of evidence

I

Risk of bias
Low risk of bias Comments: high quality systematic review methodology employed.

Risk of bias assessment: systematic review

Studies included in the review
Was an adequate search strategy used?
Very thorough – included appropriate search terms and databases
Were the inclusion criteria appropriate and applied in an unbiased way?
Yes – pre-specified inclusion criteria applied independently by two people
Were the studies assessed for quality (relating to the minimisation of biases)?
Yes – appropriate quality issues were assessed independently by two people
Were the characteristics and results of individual studies appropriately summarised?
Yes – summary descriptive tables of subjects, interventions, outcomes etc are provided and estimates of treatment effect displayed
The following questions are only relevant for systematic reviews that pooled data
Were the methods used for pooling the data appropriate?
No response
If there was heterogeneity, were sources of heterogeneity explored?
No response
Size of effect
1 Reason for decision: NLST results showed 20% relative decrease in deaths from lung cancer in the LDCT screening arm, relative risk of 0.80 (95% CI 0.73-0.93), with p=0.004.
Relevance of evidence
1 Additional comments: include results of mortality reduction by LDCT.
Result of appraisal

Jutta's tick icon.png Included



Comments

Systematic review included the three RCTs that reported the effect of LDCT screening on lung cancer specific mortality, with only the large high quality NLST trial showing significantly reduced lung cancer deaths from screening, while the smaller ongoing DANTE and DLCST studies showing no significant difference.

Authors concluded LDCT may benefit individuals at increased risk of lung cancer, but uncertainty exists about the potential harms of screening and generalisability of results.

Completed by

Associate Professor Eddie Lau FRANZCR, FAANMS


Jutta's tick icon.png This appraisal has been completed.


Article
Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA 2012 Jun 13;307(22):2418-29 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22610500.
Assigned to
User:Eddie.lau
Topic area
Guidelines:Lung cancer/Screening and early detection
Clinical question
Form
Form:Critical appraisal
Outcomes
Mortality
Study design
systematic review
Level of Evidence
I

Section below only relevant for Cancer Council Project Officer

Edit appraisal assignment