Abstract
Computed tomographic (CT) cancer screening has seen a steady increase in interest with the introduction of multislice CT scanners. The recent publication of the US National lung screening trial has proven a statistically significant reduction of cancer-related mortality and has boosted the discussion about the usefulness of introducing population-wide screening for lung cancer. While the potential benefits of screening are obvious, radiation dose may pose a long-term risk for the screened individual. This article describes the basis for radiation risk estimation and discusses the current dose controversy with special emphasis on CT screening for lung cancer. While there is no and probably never will be epidemiologic evidence for cancer induction in the dose range used for a single lung cancer screening examination, a non-negligible population risk cannot be ruled out considering the current evidence. Precise predictions of cancer risks are difficult because they depend heavily on the underlying statistical or radiobiologic model. While the risk of most radiation-induced cancers decreases with age, the relative risk of radiation-induced lung cancer peaks in the time interval between 40 and 70 years of age. However, if performed in a dose-conscious fashion, individual risks of lung cancer screening are very small and far outweighed by the published benefits of screening.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Baldwin DR, Duffy SW, Wald NJ, Page R, Hansell DM, Field JK (2011) UK lung screen (UKLS) nodule management protocol: modelling of a single screen randomised controlled trial of low-dose CT screening for lung cancer. Thorax 66(4):308–313
Becker N, Delorme S, Kauczor HU (2008) LUSI: the German component of the European trial on the efficacy of multislice-CT for the early detection of lung cancer. Onkologie 31:PO320
Berrington de Gonzalez A, Darby S (2004) Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 363:345–351 Oxford
Blanchon T, Bréchot JM, Grenier PA, Ferretti GR, Lemarié E, Milleron B, Chagué D, Laurent F, Martinet Y, Beigelman-Aubry C, Blanchon F, Revel MP, Friard S, Rémy-Jardin M, Vasile M, Santelmo N, Lecalier A, Lefébure P, Moro-Sibilot D, Breton JL, Carette MF, Brambilla C, Fournel F, Kieffer A, Frija G, Flahault A, Dépiscan Group (2007) Baseline results of the depiscan study: a French randomized pilot trial of lung cancer screening comparing low dose CT scan (LDCT) and chest X-ray (CXR). Lung Cancer 58(1):50–58
Brenner DJ (2004) Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer. Radiology 231:440–445
Brenner DJ, Elliston CD (2004) Estimated radiation risks potentially associated with full-body CT screening. Radiology 232:735–738
Brenner DJ, Georgsson MA (2005) Mass screening with CT colonography: should the radiation exposure be of concern? Gastroenterology 129:328–337
Brenner DJ, Doll R, Goodhead DT, Hall EJ, Land CE, Little JB, Lubin JH, Preston DL, Preston RJ, Puskin JS, Ron E, Sachs RK, Samet JM, Setlow RB, Zaider M (2003) Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci (PNAS) 100:13761–13766
Cardinale L, Cortese G, Borasio P, Dogliotti L, Ferraris F, Novello S, Perotto F, Scagliotti G, Fava C (2005) Low dose CT in early lung cancer diagnosis: prevalence data. Radiol Med 110(5–6):532–543
Chong S, Lee KS, Chung MJ, Kim TS et al (2005) Lung cancer screening with low-dose helical CT in Korea: experiences at the samsung medical center. J Korean Med Sci 20(3):402–408
Cohen BI (2002) Cancer risk from low level radiation. AJR 179:1137–1143
Crispo A, Brennan P, Jöckel KH et al (2004) The cumulative risk of lung cancer among current, ex- and never-smokers in European men. Br J Cancer 91(7):1280–1286
Detterbeck FC, Boffa DJ, Tanoue LT (2009) The new lung cancer staging system. Chest 136:260–271
Diederich S, Thomas M, Semik M, Lenzen H, Roos N, Weber A, Heindel W, Wormanns D (2004) Screening for early lung cancer with low-dose spiral computed tomography: results of annual follow-up examinations in asymptomatic smokers. Eur Radiol 14(4):691–702
Feinendegen LE (2005) Evidence for beneficial low level radiation effects and radiation hormesis. Br J Radiol 78(925):3–7
Ford MB, Sigurdson AJ, petrulis ES et al (2003) Effect of smoking and radiotherapy on lung carcinoma in breast cancer survivors. Cancer 98:1457–1464
Gergely I, Neumann C, Reiger F, Dorffner R (2005) Lung nodule detection with ultra-low-dose CT in routine follow-up of cancer patients. Rofo 177(8):1077–1083
Gilbert ES, Stovall M, Gospodarowicz M et al (2003) Lung cancer after treatment for Hofgkin’s disease: focus on radiation effects. Radiat Res 159:151–173
Godoy MC, Naidich DP (2009) Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung: recommended interim guidelines for assessment and management. Radiology 253(3):606–622, Review
Gohagan J, Marcus P, Fagerstrom R, Pinsky P, Kramer B, Prorok P, Writing Committee, Lung Screening Study Research Group (2004) Baseline findings of a randomized feasibility trial of lung cancer screening with spiral CT scan vs chest radiograph: the lung screening study of the national cancer institute. Chest 126(1):114–121
Goodman LR, Lipchik RJ, Kuzo RS, Liu Y, McAuliffe TL, O’Brien DJ (2000) Subsequent pulmonary embolism: risk after a negative helical CT pulmonary angiogram—prospective comparison with scintigraphy. Radiology 215:535–542
Hendrick RE (2010) Radiation doses and cancer risks from breast imaging studies. Radiology 257:246–253
Henschke CI, McCauley DI, Yankelevitz DF et al (1999) Early lung cancer action project: overall design and findings from baseline screening. Lancet 354:99–105
Honda O, Yanagawa M, Inoue A et al (2011) Image quality of multiplanar reconstruction of pulmonary CT scans using adaptive statistical iterative reconstruction. Br J Radiol 84(1000):335–341
Hu XH, Ding XF, Wu RZ, Zhang MM (2011) Radiation dose of non-enhanced chest CT can be reduced 40% by using iterative reconstruction in image space. Clin Radiol 66(11):1023–1029
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 (2009) A randomized study of lung cancer screening with spiral computed tomography: three-year results from the DANTE trial. Am J Respir Crit Care Med 180(5):445–453
Jett RJ (2005) Limitations of screening for lung cancer with low-dose spiral computed tomography. Clin Cancer Res 11:4988s–4992s
Kachelriess M, Watzke O, Kalender WA (2001) Generalized multi-dimensional adaptive filtering for conventional and spiral single-slice, multi-slice, and cone-beam CT. Med Phys 28:475–490
Kalender WA, Wolf H, Suess C, Gies M, Greess H, Bautz WA (1999) Dose reduction in CT by on-line tube current control: principles and validation on phantoms and cadavers. Eur Radiol 9(2):323–328
Kalra MK, Rizzo S, Maher MM, Halpern EF, Toth TL, Shepard JA, Aquino SL (2005) Chest CT performed with Z-axis modulation: scanning protocol and radiation dose. Radiology 237:303–308
Kramer BS, Berg CD, Aberle DR, Prorok PC (2011) Lung cancer screening with low-dose helical CT: results from the national lung screening trial (NLST). J Med Screen 18(3):109–111
Little JB (1999) Induction of genetic instability by ionizing radiation. C R Acad Sci III 322:127–134
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 (2009) Design, recruitment and baseline results of the ITALUNG trial for lung cancer screening with low-dose CT. Lung Cancer 64(1):34–40
MacRedmond R, McVey G, Lee M, Costello RW, Kenny D, Foley C, Logan PM (2006) Screening for lung cancer using low dose CT scanning: results of 2 year follow up. Thorax 61(1):54–56
Marcus PM, Bergstralh EJ, Zweig MH et al (2006) Extended lung cancer incidence follow-up in the Mayo lung project and overdiagnosis. J Nat Cancer Inst 98:748–756
Mascalchi M, Belli G, Zappa M et al (2006) Risk-Benefit analysis of X-ray exposure associated with lung cancer screening in the ITALUNG CT trial. AJR 187:421–429
Melamad MR, Flehinger BJ, Zaman MB et al (1984) Screening for lung cancer; results of the Memorial Sloan Kettering study in New York. Chest 86:44–53
Menezes RJ, Roberts HC, Paul NS, McGregor M, Chung TB, Patsios D, Weisbrod G, Herman S, Pereira A, McGregor A, Dong Z, Sitartchouk I, Boerner S, Tsao MS, Keshavjee S, Shepherd FA (2010) Lung cancer screening using low-dose computed tomography in at-risk individuals: the Toronto experience. Lung Cancer 7(2):177–183
Mettler FA, Bhargavan M, Faulkner K et al (2009) Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose and comparison with other radiation sources—1950–2007. Radiology 253:520–531
Mulkens TH, Bellinck P, Baeyaert M, Ghysen D, Van Dijck X, Mussen E, Venstermans C, Termote JL (2005) Use of an automatic exposure control mechanism for dose optimization in multi-detector row CT examinations: clinical evaluation. Radiology 237(1):213–223
National Lung Screening Trial Research Team (2011) The national lung screening trial: overview and study design. Radiology 258:243–253
National Research Council (1990) Committee on the biological effects of ionizing radiations. Health effects of exposure to low levels of ionizing radiation: BEIR V. National Academy Press, Washington, DC
National Research Council Committee on the Biological Effects of Ionizing Radiations (2005) Health effects of exposure to low levels of ionizing radiation: BEIR VII. National Academy Press, Washington, DC
National Research Council of the National Academics (2006) Health risks from exposure to low levels of ionizing radiation. BEIR VII, phase 2—Committee to assess health risks from exposure to low levels of ionizing radiation. National Academic Press, Washington, DC
Nawa T, Nakagawa T, Kusano S, Kawasaki Y, Sugawara Y, Nakata H (2002) Lung cancer screening using low-dose spiral CT: results of baseline and 1-year follow-up studies. Chest 122(1):15–20
New York Early Lung Cancer Action Project Investigators (2007) CT screening for lung cancer: diagnoses resulting from the New York early lung cancer action project. Radiology 243(1):239–249
Pastorino U (2010) Lung cancer screening (mini review). Br J Cancer 102:1681–1686
Pastorino U, Bellomi M, Landoni C, De Fiori E, Arnaldi P, Picchio M, Pelosi G, Boyle P, Fazio F (2003) Early lung-cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results. Lancet 362(9384):593–597
Pastorino U (2006) Early detection of lung cancer. Respiration 73(1):5–13
Pedersen JH, Ashraf H, Dirksen A, Bach K, Hansen H, Toennesen P, Thorsen H, Brodersen J, Skov BG, Døssing M, Mortensen J, Richter K, Clementsen P, Seersholm N (2009) The Danish randomized lung cancer CT screening trial—overall design and results of the prevalence round. J Thorac Oncol 4(5):608–614
Pierce DA, Preston DL (2000) Radiation-related cancer risks at low doses among atomic bomb survivors. Radiat Res 154:178–186
Pontana F, Pagniez J, Flohr T et al (2011) Chest computed tomography using iterative reconstruction vs filtered back projection (Part 1): evaluation of image noise reduction in 32 patients. Eur Radiol 21(3):627–635
Preston DL, Ron E, Tokuoka S, Funamoto S, Nishi N, Soda M, Mabuchi K, Kodama K (2007) Solid cancer incidence in atomic bomb survivors: 1958–1998. Radiat Res 168(1):1–64
Reduced lung-cancer mortality with low-dose computed tomographic screening (2011) The national lung screening trial research team. NEJM 365:395–409
Swensen SJ, Jett JR, Hartman TE, Midthun DE, Mandrekar SJ, Hillman SL, Sykes AM, Aughenbaugh GL, Bungum AO, Allen KL (2005) CT screening for lung cancer: five-year prospective experience. Radiology 235(1):259–265
Thompson DE, Mabuchi K, Ron E et al (1994) Cancer incidence in atomiv bomb survivors. Part II. Solid tumors, 1958–1987. Rad Res 137(suppl 2):S17–S67
Tokarskaya ZB, Scott BR, Zhuntova GV et al (2002) Interaction of radiation and smoking in lung cancer induction among workers at the Mayak nuclear enterprise. Health Phys 83:833–846
Tubiana M, Feinendegen LE, Yang C, Kamisnki JM (2009) The linear no-threshold is inconsistent with radiation biologic and experimental data. Radiology 251:13–22
Vaino H, Bianchini F (eds) (2002) International agency for the research on Cancer. Breast cancer screening handbook of cancer prevention, vol 7. International Agency for the Research on Cancer, Lyon, pp 91–107
van Klaveren RJ, Oudkerk M, Prokop M, Scholten ET, Nackaerts K, Vernhout R, van Iersel CA, van den Bergh KA, van‘t Westeinde S, van der Aalst C, Thunnissen E, Xu DM, Wang Y, Zhao Y, Gietema HA, de Hoop BJ, Groen HJ, de Bock GH, van Ooijen P, Weenink C, Verschakelen J, Lammers JW, Timens W, Willebrand D, Vink A, Mali W, de Koning HJ (2009) Management of lung nodules detected by volume CT scanning. N Engl J Med 361(23):2221–2229
Veronesi G, Bellomi M, Mulshine JL, Pelosi G, Scanagatta P, Paganelli G, Maisonneuve P, Preda L, Leo F, Bertolotti R, Solli P, Spaggiari L (2008) Lung cancer screening with low-dose computed tomography: a non-invasive diagnostic protocol for baseline lung nodules. Lung Cancer 61(3):340–349
Xu DM, Gietema H, de Koning H et al (2006) Nodule management protocol of the Nelson randomized lung cancer screening trial. Lung Cancer 54:177–184
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Schaefer-Prokop, C., van Muiswinkel, K., Prokop, M. (2011). Radiation Risk Associated with Lung Cancer Screening. In: Tack, D., Kalra, M., Gevenois, P. (eds) Radiation Dose from Multidetector CT. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_491
Download citation
DOI: https://doi.org/10.1007/174_2011_491
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-24534-3
Online ISBN: 978-3-642-24535-0
eBook Packages: MedicineMedicine (R0)