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Review of the Radiation Risk and Clinical Efficacy Associated with Computed Tomography Cancer Screening
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 Title & Authors
Review of the Radiation Risk and Clinical Efficacy Associated with Computed Tomography Cancer Screening
Kim, Hyun Ja;
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 Abstract
Computed tomographic scan as a screening procedures in asymptomatic individuals has seen a steady increase with the introduction of multiple-raw detector CT scanners. This report provides a brief review of the current controversy surrounding CT cancer screening, with a focus on the radiation induced cancer risks and clinical efficacy. 1. A large study of patients at high risk of lung cancer(the National Lung Screening Trial[NLST]) showed that CT screening reduced cancer deaths by 20%(1.33% in those screened compared with 1.67% in those not screened). The rate of positive screening tests was 24.2% and 96.4% of the positive screening results in the low-dose CT group were false-positive. Radiation induced lung cancer risk was estimated the most important in screening population because ERR of radiation induced lung cancer does not show the decrease with increasing age and synergistic connection between smoking and radiation risk. Therefore, the radiation risk may be on the same order of magnitude as the benefit observed in the NLST. Optimal screening strategy remain uncertain, CT lung cancer screening is not yet ready for implementation. 2. Computed tomographic colonography is as good as colonoscopy for detecting colon cancer and is almost as good as colonoscopy for detecting advanced adenomas, but significantly less sensitive and specific for smaller lesions and disadvantageous for subsequent therapeutic optical colonoscopy if polyps are detected. The average effective dose from CT colonography was estimated 8-10 , which could be a significant dose if administered routinely within the population over many years. CT colonography should a) achieve at least 90% sensitivity and specificity in the size category from 6 and 10 mm, b) offer non-cathartic bowl preparation and c) be optimized and standardized CT parameters if it is to be used for mass screening. 3. There is little evidence that demonstrates, for whole-body scanning, the benefit outweighs the detriment. This test found large portion of patient(86~90.8%) had at least one abnormal finding, whereas only 2% were estimated to have clinically significant disease. Annual scans from ages 45 to 75 years would accrue an estimated lifetime cancer mortality risk of 1.9%. There is no group within the medical community that recommends whole-body CT. No good studies indicate the accuracy of screening CT, at this time. The benefit/risk balance for any of the commonly suggested CT screening techniques has yet to be established. These areas need further research. Therefore wild screening should be avoided.
 Keywords
Computed Tomography;Cancer screening;ERR;low-dose CT (LDCT);CT colonoscopy (CTC);Whole-body CT(WBCT);
 Language
Korean
 Cited by
 References
1.
Organization for Economic Cooperation and Development. OECD health care resources. http://stats.oecd.org

2.
National health insurance statistical yearbook. 2012.

3.
National Council on Radiation Protection and Measurements. National Council on Radiation Protection Report no. 160. Ionizing radiation exposure of the population of the United States(2009). Bethesda, MD, USA. 2009.

4.
You JJ, Levinson W, Laupacis A. Attitudes of family physicians, specialists and radiologists about the use of computed tomography and magnetic resonance imaging in Ontario. Health Policy. 2009;5(1):54-65.

5.
Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, Berrington de Gonzalez A, Miglioretti DL. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch. Intern. Med. 2009;169(22):2078-2086. crossref(new window)

6.
Obuchowski NA, Graham RJ, Baker ME, Powell KA. Ten criteria for effective screening: their application to multislice CT screening for pulmonary and colorectal cancers. Am. J. Roentgenol. 2001:176(6):1357-1362. crossref(new window)

7.
Cole P. Morrison AS. Basic issues in population screening for patients. J. Natl. Cancer Inst. 1980:64:1263-1272.

8.
Black WC, Welch HG. Screening for disease. Am. J. Roentgenol. 1997;168(1):3-11. crossref(new window)

9.
Herman CR, Gill HK, Eng J, Fajardo LL. Screening for preclinical disease: test and disease characteristics. Am. J. Roentgenol. 2002;179(4):825-831. crossref(new window)

10.
Black WC, Welch HG. Advances in diagnostic imaging and overestimation of disease prevalence and the benefits of therapy. N. Engl. J. Med. 1993;328(17):1237-1243. crossref(new window)

11.
Morrison AS. Screening in chronic disease. 2nd ed. New York. Oxford University Press. 1992:25-42.

12.
Laupacis A, Sackett DL, Roberts RS. An assessment of clinically useful measures of the consequences of treatment. N. Engl. J. Med. 1988:318(26):1728-1733. crossref(new window)

13.
National Research Council (US). Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation. Health risks from exposure to low levels of ionizing radiation, BEIR VII phase 2. Washington DC. USA. 2006.

14.
http://www.index.go.kr/egams/stts/jsp/potal/stts/PO_STTS_IdxMain.jsp?idx_cd=2770

15.
Henschke CI, McCauley DI, Yankelevitz DF, Naidich DP, McGuinness G, Miettinen OS, Libby DM, Pasmantier MW, Koizumi J, Altorki NK, Smith JP. Early lung cancer action project: overall design and findings from baseline screening. Lancet. 1999;354:99-105. crossref(new window)

16.
Henschke CI, Naidich DP, Yankelevitz DF, McGuinness G, McCauley DI, Smith JP, Libby D, Pasmantier M, Vazquez M, Koizumi J, Flieder D, Altorki N, Miettinen OS. Early lung cancer action project: initial findings on repeat screenings. Cancer. 2001;92(1):153-159. crossref(new window)

17.
International Early Lung Cancer Action Program Investigators, Henschke CI, Yankelevitz DF, Libby DM, Pasmantier MW, Smith JP, Miettinen OS. Survival of patients with stage I lung cancer detected on CT screening. N. Engl. J. Med. 2006;355(17):1763-1771. crossref(new window)

18.
Sone S, Li F, Yang ZG, et al. Results of three-year mass screening programme for lung cancer using mobile low-dose spiral computed tomography scanner. Br. J. Cancer. 2001;84(1):25-32. crossref(new window)

19.
Nawa T, Nakagawa T, Kusano S, Kawasaki Y, Sugawara Y, Nakata H. Lung cancer screening using low-dose spiral CT: results of baseline and 1-year follow-up studies. Chest. 2002;122(1):15-20. crossref(new window)

20.
Sobue T, Moriyama N, Kaneko M, et al. Screening for lung cancer with low-dose helical computed tomography:anti-lung cancer association project. J. Clin. Oncol. 2002;20(4):911-920. crossref(new window)

21.
Swensen SJ, Jett JR, Hartman TE, Midthun DE, Sloan JA, Sykes AM, Aughenbaugh GL, Clemens MA. Lung cancer screening with CT: Mayo Clinic experience. Radiology. 2003;226(3):756-761. crossref(new window)

22.
Pastorino U, Bellomi M, Landoni C, De Fiori E, Arnaldi P, Picchio M, Pelosi G, Boyle P, Fazio F. Early lung-cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results. Lancet. 2003;362:593-597. crossref(new window)

23.
Mulshine JL, Sullivan DC. Clinical practice. Lung cancer screening. N. Engl. J. Med. 2005;352(26):2714-2720. crossref(new window)

24.
Libby DM, Wu N, Lee IJ, Farooqi A, Smith JP, Pasmantier MW, McCauley D, Yankelevitz DF, Henschke CI. CT screening for lung cancer:the value of short-term CT follow-up. Chest. 2006;129(4):1039-1042. crossref(new window)

25.
MacRedmond R, McVey G, Lee M, Costello RW, Kenny D, Foley C, Logan PM. Screening for lung cancer using low dose CT scanning: results of 2 year follow up. Thorax. 2006;61(1):54-56.

26.
Bach PB, Niewoehner DE, Black WC. American College of Chest Physicians. Screening for lung cancer: the guidelines. Chest. 2003;123:83S-88S. crossref(new window)

27.
Paci E. Observational, one-arm studies and randomized population-based trials for evaluation of the efficacy of lung cancer screening. J. Thorac. Oncol. 2007;2:S45-S46. crossref(new window)

28.
Infante M, Lutman FR, Cavuto S, Brambilla G, Chiesa G, Passera E, Angeli E, Chiarenza M, Aranzulla G, Cariboni U, Alloisio M, Incarbone M, Testori A, Destro A, Cappuzzo F, Roncalli M, Santoro A, Ravasi G, DANTE Study Group. Lung cancer screening with spiral CT Baseline results of the randomized DANTE trial. Lung Cancer. 2008;59(3):355-363. crossref(new window)

29.
Infante M, Cavuto S, Lutman FR, Brambilla G, Chiesa G, Ceresoli G, Passera E, Angeli E, Chiarenza M, Aranzulla G, Cariboni U, Errico V, Inzirillo F, Bottoni E, Voulaz E, Alloisio M, Destro A, Roncalli M, Santoro A, Ravasi G, DANTE Study Group. A randomized Study of lung cancer screening with spiral computed tomography: three-year results from the DANTE Trial. Am. J. Respir. Crit. Care Med. 2009;180(5):445-453. crossref(new window)

30.
Clark KW, Gierada DS, Marquez G, Moore SM, Maffitt DR, Moulton JD, Wolfsberger MA, Koppel P, Phillips SR, Prior FW. Collecting 48,000 CT Exams for the lung screening study of the National Lung Screening Trial. J. Digit. Imaging. 2009;22(6):667-680. crossref(new window)

31.
van Iersel CA, de Koning HJ, Draisma G, Mali WP, Scholten ET, Nackaerts K, Prokop M, Habbema JD, Oudkerk M, van Klaveren RJ. Risk-based selection from the general population in a screening trial: selection criteria, recruitment and power for the Dutch-Belgian randomised lung cancer multi-slice CT screening trial(NELSON). Int. J. Cancer. 2007;120(4):868-874. crossref(new window)

32.
Pedersen JH, Ashraf H, Dirksen A, Bach K, Hansen H, Toennesen P, Thorsen H, Brodersen J, Skov BG, Dossing M, Mortensen J, Richter K, Clementsen P, Seersholm N. The Danish randomized lung cancer CT screening trial-overall design and results of the prevalence round. J. Thorac. Oncol. 2009;4(5):608-614. crossref(new window)

33.
Lopes Pegna A, Picozzi G, Mascalchi M, Maria Carozzi F, Carrozzi L, Comin C, Spinelli C, Falaschi F, Grazzini M, Innocenti F, Ronchi C, Paci E, ITALUNG Study Research Group. Design, recruitment and baseline results of the ITALUNG trial for lung cancer screening with low-dose CT. Lung Cancer. 2009;64(1):34-40. crossref(new window)

34.
National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM, Sicks JD. Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. N. Engl. J. Med. 2011;365(5):395-409. crossref(new window)

35.
Boiselle PM, Lynm C, Livingston EH. JAMA patient page. Lung cancer screening. JAMA. 2013;309(18):1948. crossref(new window)

36.
Christensen JD, Tong BC. Computed tomography screening for lung cancer: where are we now? N. C. Med J. 2013;74(5):406-410.

37.
Thompson DE, Mabuchi K, Ron E, Soda M, Tokunaga M, Ochikubo S, Sugimoto S, Ikeda T, Terasaki M, Izumi S, et al. Cancer incidence in atomic bomb survivors. Part II. Solid tumors, 1958-1987. Radiat. Res. 1994;137(2 suppl):S17-S67. crossref(new window)

38.
National Research Council. Committee on the Biological Effects of Ionizing Radiations Health effects of exposure to low levels of ionizing radiation: BEIR V. Washington, DC: National Academy Press. 1990.

39.
Brenner DJ. Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer. Radiology. 2004;231(2):440-445. crossref(new window)

40.
Pierce, D.A., G.B. Sharp, and K. Mabuchi. Joint effects of radiation and smoking on lung cancer risk among atomic bomb survivors. Radiat. Res. 2003;159(4):511-520. crossref(new window)

41.
Tokarskaya ZB, Scott BR, Zhuntova GV, Okladnikova ND, Belyaeva ZD, Khokhryakov VF, Schollnberger H, Vasilenko EK. Interaction of radiation and smoking in lung cancer induction among workers at the Mayak nuclear enterprise. Health Phys. 2002;83(6):833-846. crossref(new window)

42.
Preston DL, Ron E, Tokuoka S, Funamoto S, Nishi N, Soda M, Mabuchi K, Kodama K. Solid cancer incidence in atomic bomb survivors: 1958-1998. Radiat. Res. 2007;168(1):1-64. crossref(new window)

43.
Nishizawa K, Iwai K, Matsumoto T, Sakashita K, Iinuma TA, Tateno Y, Miyamoto T, Shimura A, Takagi H. Estimation of the exposure and a risk-benefit analysis for a CT system designed for a lung cancer mass screening unit. Radiat. Prot. Dosimetry. 1996;67(2):101-108. crossref(new window)

44.
Albert JM. Radiation risk from CT: implications for cancer screening. Am. J. Roentgenol. 2013;201(1):W81-87. crossref(new window)

45.
Lee CI, Haims AH, Monico EP, Brink JA, Forman HP. Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology. 2004;231(2):393-398. crossref(new window)

46.
Italian Multicentre Study Group, Citarda F, Tomaselli G, Capocaccia R, Barcherini S, Crespi M. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut. 2001;48(6):812-815. crossref(new window)

47.
Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer: Veterans Affairs Cooperative Study Group 380. N. Engl. J. Med. 2000;343(3):162-168 crossref(new window)

48.
Coin CG, Wollett FC, Coin JT, Rowland M, DeRamos RK, Dandrea R. Computerized radiology of the colon: a potential screening technique. Comput. Radiol. 1983;7(4):215-221. crossref(new window)

49.
Pickhardt PJ, Kim DH. CT colonography (virtual colonoscopy): a practical approach for population screening. Radiol. Clin. North Am. 2007;45(2):361-375. crossref(new window)

50.
van Dam J, Cotton P, Johnson CD, McFarland BG, Pineau BC, Provenzale D, Ransohoff D, Rex D, Rockey D, Wootton FT 3rd. American Gastroenterological Association. AGA future trends report: CT colonography. Gastroenterology. 2004;127(3):970-984. crossref(new window)

51.
Pickhardt PJ, Choi JR, Hwang I, Butler JA, Puckett ML, Hildebrandt HA, Wong RK, Nugent PA, Mysliwiec PA, Schindler WR. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N. Engl. J. Med. 2003;349(23):2191-2200. crossref(new window)

52.
Brenner D, Georgsson MA. Mass screening with CT colonography: should the radiation exposure be of concern? Gastroenterology. 2005;129(1):328-337. crossref(new window)

53.
Macari M, Bini EJ, Xue X, Milano A, Katz SS, Resnick D, Chandarana H, Krinsky G, Klingenbeck K, Marshall CH, Megibow AJ. Colorectal neoplasms: prospective comparison of thin-section low-dose multi-detector row CT colonography and conventional colonoscopy for detection. Radiology. 2002;224(2):383-92. crossref(new window)

54.
Halligan S, Altman DG, Taylor SA, et al. CT colonography in the detection of colorectal polyps and cancer: systematic review, meta-analysis, and proposed minimum data set for study level reporting. Radiology. 2005;237(3):893-904. crossref(new window)

55.
Taylor SA, Slater A, Burling DN, Tam E, Greenhalgh R, Gartner L, Scarth J, Pearce R, Bassett P, Halligan S. CT colonography: optimisation, diagnostic performance and patient acceptability of reduced-laxative regimens using barium-based faecal tagging. Eur. Radiol. 2008;18(1):32-42. crossref(new window)

56.
Zalis ME, Perumpillichira JJ, Magee C, Kohlberg G, Hahn PF. Tagging-based, electronically cleansed CT colonography: evaluation of patient comfort and image readability. Radiology. 2006;239(1):149-159. crossref(new window)

57.
Regge D, Laudi C, Galatola G, Della Monica P, Bonelli L, Angelelli G, Asnaghi R, Barbaro B, Bartolozzi C, Bielen D, Boni L, Borghi C, Bruzzi P, Cassinis MC, Galia M, Gallo TM, Grasso A, Hassan C, Laghi A, Martina MC, Neri E, Senore C, Simonetti G, Venturini S, Gandini G. Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer. JAMA. 2009;301(23):2453-2461. crossref(new window)

58.
Berrington de Gonzalez A, Kim KP, Berg CD. Low-dose lung computed tomography screening before age 55:estimates of the mortality reduction required to outweigh the radiation-induced cancer risk. J. Med. Screen. 2008;15(3):153-158. crossref(new window)

59.
Johnson CD, Chen MH, Toledano AY, Heiken JP, Dachman A, Kuo MD, Menias CO, Siewert B, Cheema JI, Obregon RG, Fidler JL, Zimmerman P, Horton KM, Coakley K, Iyer RB, Hara AK, Halvorsen RA Jr, Casola G, Yee J, Herman BA, Burgart LJ, Limburg PJ. Accuracy of CT colonography for detection of large adenomas and cancers. N. Engl. J. Med. 2008;359(12):1207-1217. crossref(new window)

60.
Flicek KT, Hara AK, Silva AC, Wu Q, Peter MB, Johnson CD. Reducing the radiation dose for CT colonography using adaptive statistical iterative reconstruction: a pilot study. Am. J. Roentgenol. 2010;195(1):126-131. crossref(new window)

61.
Taylor SA, Halligan S, Bartram CI, Morgan PR, Talbot IC, Fry N, Saunders BP, Khosraviani K, Atkin W. Multi-detector row CT colonography: effect of collimation, pitch, and orientation on polyp detection in a human colectomy specimen. Radiology. 2003;229(1):109-118. crossref(new window)

62.
van Gelder RE, Venema HW, Serlie IW, Nio CY, Determann RM, Tipker CA, Vos FM, Glas AS, Bartelsman JF, Bossuyt PM, Lameris JS, Stoker J. CT colonography at different radiation dose levels: feasibility of dose reduction. Radiology. 2002;224(1):25-33. crossref(new window)

63.
Illes J, Fan E, Koenig BA, Raffin TA, Kann D, Atlas SW. Self-referred whole-body CT imaging: current implications for health care consumers. Radiology. 2003;228(2):346-351. crossref(new window)

64.
Berland LL, Berland NW. Whole-body computed tomography screening. Semin. Roentgenol. 2003;38(1):65-76.

65.
Casarella WJ. A patient's viewpoint on a current controversy. Radiology. 2002;224(3):927. crossref(new window)

66.
Beinfeld MT, Wittenberg E, Gazelle GS. Cost-effectiveness of whole-body CT screening. Radiology. 2005;234(2):415-422. crossref(new window)

67.
Furtado CD, Aguirre DA, Sirlin CB, Dang D, Stamato SK, Lee P, Sani F, Brown MA, Levin DL, Casola G. Whole-body CT screening: spectrum of findings and recommendations in 1192 patients. Radiology. 2005;237(2):385-394. crossref(new window)

68.
Brenner DJ, Elliston CD. Estimated radiation risks potentially associated with full-body CT screening. Radiology. 2004;232(3):735-738. crossref(new window)

69.
http://www.radiologyinfo.org/en/news/newdetarget.cfm?ID=5