Lung Cancer Screening and Elderly Adults: Do We Have Sufficient Evidence?
Authors: Michael K. Gould
Journal: Annals of Internal Medicine (2014)

Editorials4 November 2014Lung Cancer Screening and Elderly Adults: Do We Have Sufficient Evidence?Michael K. Gould, MD, MSMichael K. Gould, MD, MSFrom Kaiser Permanente Southern California, Pasadena, California.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-2006 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Randomized, controlled trials are a jewel in the crown of evidence-based medicine, but randomization alone does not guarantee that study results are free from bias and universally applicable. When results are being translated from clinical trials to clinical practice, several sources of uncertainty should be considered, such as inconsistency (heterogeneity) of results across studies, imprecision in the estimates of benefits and harms, and indirectness of the evidence to the question at hand (1). Indirectness is a potentially important threat to generalizability when the research question addresses a different population, intervention, comparator, outcome, or setting from the one confronting the clinician ...References1. Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64:401-6. [PMID: 21208779] doi:10.1016/j.jclinepi.2010.07.015 CrossrefMedlineGoogle Scholar2. Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al; GRADE Working Group. GRADE guidelines: 8. Rating the quality of evidence—indirectness. J Clin Epidemiol. 2011;64:1303-10. [PMID: 21802903] doi:10.1016/j.jclinepi.2011.04.014 CrossrefMedlineGoogle Scholar3. Rothwell PM. External validity of randomised controlled trials: “to whom do the results of this trial apply?”. Lancet. 2005;365:82-93. [PMID: 15639683] CrossrefMedlineGoogle Scholar4. Aberle DR, Berg CD, Black WC, Church TR, Fagerstrom RM, Galen B, et al; National Lung Screening Trial Research Team. The National Lung Screening Trial: overview and study design. Radiology. 2011;258:243-53. [PMID: 21045183] doi:10.1148/radiol.10091808 CrossrefMedlineGoogle Scholar5. Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395-409. [PMID: 21714641] doi:10.1056/NEJMoa1102873 CrossrefMedlineGoogle Scholar6. Centers for Medicare & Medicaid Services. MEDCAC Meeting 4/30/2014—Lung Cancer Screening with Low-Dose Computed Tomography. Baltimore: Centers for Medicare & Medicaid Services; 2014. Accessed at www.cms.gov/medicare-coverage-database/details/medcac-meeting-details.aspx?MEDCACId=68#agenda on 27 August 2014. Google Scholar7. Wiener RS. Balancing the benefits and harms of low-dose computed tomography screening for lung cancer: Medicare's options for coverage. Ann Intern Med. 2014;161:445-6. doi:10.7326/M14-1352 LinkGoogle Scholar8. Kinsinger LS, Atkins D, Provenzale D, Anderson C, Petzel R. Implementation of a new screening recommendation in health care: the Veterans Health Administration's approach to lung cancer screening. Ann Intern Med. 2014;161:597-8. doi:10.7326/M14-1070 LinkGoogle Scholar9. Pinsky PF, Church TR, Izmirlian G, Kramer BS. The National Lung Screening Trial: results stratified by demographics, smoking history, and lung cancer histology. Cancer. 2013;119:3976-83. [PMID: 24037918] doi:10.1002/cncr.28326 CrossrefMedlineGoogle Scholar10. Pinsky PF, Gierada DS, Hocking W, Patz EF, Kramer BS. National Lung Screening Trial findings by age: Medicare-eligible versus under-65 population. Ann Intern Med. 2014;161:627-33. doi:10.7326/M14-1484 LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Michael K. Gould, MD, MSAffiliations: From Kaiser Permanente Southern California, Pasadena, California.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2006.Corresponding Author: Michael K. Gould, MD, MS, Director for Health Services Research and Implementation Science, Department of Research and Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, Suite 304, Pasadena, CA 91101. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoNational Lung Screening Trial Findings by Age: Medicare-Eligible Versus Under-65 Population Paul F. Pinsky , David S. Gierada , William Hocking , Edward F. Patz Jr. , and Barnett S. Kramer National Lung Screening Trial Findings by Age: Medicare-Eligible Versus Under-65 Population Paul F. Pinsky , David S. Gierada , William Hocking , Edward F. Patz Jr. , and Barnett S. Kramer Metrics Cited byPersonalised Lung Cancer Screening (PLuS) study to assess the importance of coexisting chronic conditions to clinical practice and policy: protocol for a multicentre observational studyComorbidity Profiles and Lung Cancer Screening among Older Adults: U.S. Behavioral Risk Factor Surveillance System 2017–2019Complication Rates and Downstream Medical Costs Associated With Invasive Diagnostic Procedures for Lung Abnormalities in the Community SettingSmoking pattern and risk of lung cancer among women participating in cancer screening programmesLung Cancer in the Older PatientBayesian prediction of lung and breast cancer mortality among women in Spain (2014–2020)Why and how would we implement a lung cancer screening program? 4 November 2014Volume 161, Issue 9Page: 672-673KeywordsAge groupsClinical trialsDiagnostic radiologyDisclosureLung and intrathoracic tumorsLungsMedicareMortalityRelative riskVeteran care ePublished: 4 November 2014 Issue Published: 4 November 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. 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