Abstract:
:Objective To estimate the cumulative radiation exposure and lifetime attributable risk of cancer incidence associated with lung cancer screening using annual low dose computed tomography (CT).Design Secondary analysis of data from a lung cancer screening trial and risk-benefit analysis.Setting 10 year, non-randomised, single centre, low dose CT, lung cancer screening trial (COSMOS study) which took place in Milan, Italy in 2004-15 (enrolment in 2004-05). Secondary analysis took place in 2015-16.Participants High risk asymptomatic smokers aged 50 and older, who were current or former smokers (≥20 pack years), and had no history of cancer in the previous five years.Main outcome measures Cumulative radiation exposure from low dose CT and positron emission tomography (PET) CT scans, calculated by dosimetry software; and lifetime attributable risk of cancer incidence, calculated from the Biological Effects of Ionizing Radiation VII (BEIR VII) report.Results Over 10 years, 5203 participants (3439 men, 1764 women) underwent 42 228 low dose CT and 635 PET CT scans. The median cumulative effective dose at the 10th year of screening was 9.3 mSv for men and 13.0 mSv for women. According to participants' age and sex, the lifetime attributable risk of lung cancer and major cancers after 10 years of CT screening ranged from 5.5 to 1.4 per 10 000 people screened, and from 8.1 to 2.6 per 10 000 people screened, respectively. In women aged 50-54, the lifetime attributable risk of lung cancer and major cancers was about fourfold and threefold higher than for men aged 65 and older, respectively. The numbers of lung cancer and major cancer cases induced by 10 years of screening in our cohort were 1.5 and 2.4, respectively, which corresponded to an additional risk of induced major cancers of 0.05% (2.4/5203). 259 lung cancers were diagnosed in 10 years of screening; one radiation induced major cancer would be expected for every 108 (259/2.4) lung cancers detected through screening.Conclusion Radiation exposure and cancer risk from low dose CT screening for lung cancer, even if non-negligible, can be considered acceptable in light of the substantial mortality reduction associated with screening.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Rampinelli C,De Marco P,Origgi D,Maisonneuve P,Casiraghi M,Veronesi G,Spaggiari L,Bellomi Mdoi
10.1136/bmj.j347subject
Has Abstractpub_date
2017-02-08 00:00:00pages
j347eissn
0959-8138issn
1756-1833journal_volume
356pub_type
杂志文章abstract:OBJECTIVE:To investigate differences between hospitals in clinical management of patients admitted with fractured hip and to relate these to mortality at 90 days. DESIGN:A prospective audit of process and outcome of care based on interviews with patients, abstraction from records with standard proforma, and follow up ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.310.6984.904
更新日期:1995-04-08 00:00:00
abstract:OBJECTIVE:To discover whether the wartime government evacuation of children from London and other population centres to rural districts was associated with any increase in childhood leukaemia. DESIGN:Observational study of mortality from leukaemia among the childhood population of England and Wales in relation to the ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.309.6963.1197
更新日期:1994-11-05 00:00:00
abstract:OBJECTIVES:To evaluate integrated care for diabetes in clinical, psychosocial, and economic terms. DESIGN:Pragmatic randomised trial. SETTING:Hospital diabetic clinic and three general practice groups in Grampian. PATIENTS:274 adult diabetic patients attending a hospital clinic and registered with one of three gener...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1994-05-07 00:00:00
abstract:OBJECTIVE:To compare ultrasonography with intravenous urography in the investigation of adults with haematuria. DESIGN:Prospective study entailing the examination of all patients with both investigations concurrently. The investigations were performed independently on routine lists by different duty radiologists. Each...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章
doi:10.1136/bmj.301.6760.1074
更新日期:1990-11-10 00:00:00
abstract:OBJECTIVE:To estimate trends between 1972-6 and 1996 in the prevalences of asthma and hay fever in adults. DESIGN:Two epidemiological surveys 20 years apart. Identical questions were asked about asthma, hay fever, and respiratory symptoms at each survey. SETTING:Renfrew and Paisley, two towns in the west of Scotland....
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.321.7253.88
更新日期:2000-07-08 00:00:00
abstract:OBJECTIVE:To determine if sufficient evidence exists to support the use of magnetic resonance angiography as a means of selecting patients with recently symptomatic high grade carotid stenosis for surgery. DESIGN:Systematic review of published research on the diagnostic performance of magnetic resonance angiography, 1...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.324.7331.198
更新日期:2002-01-26 00:00:00
abstract::Lung cancer, the most prevalent cancer in the Western world, is mainly caused by smoking. Nevertheless, only 20% of smokers develop lung cancer and while prevention is important, environmental factors are expected to contribute to the predicted rise in the incidence of lung cancer in the next 25 years. Survival of lun...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.314.7081.652
更新日期:1997-03-01 00:00:00
abstract:OBJECTIVE:To identify the number of patients who were misdiagnosed as being in the vegetative state and their characteristics. DESIGN:Retrospective study of the clinical records of the medical, occupational therapy, and clinical psychology departments. SETTING:20 bed unit specialising in the rehabilitation of patient...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7048.13
更新日期:1996-07-06 00:00:00
abstract:OBJECTIVE:To determine the prevalence of severe psychological trauma --that is, post-traumatic stress disorder--in children involved in everyday road traffic accidents. DESIGN:12 month prospective study. SETTING:Accident and emergency department, Royal United Hospital, Bath. SUBJECTS:119 children aged 5-18 years inv...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.317.7173.1619
更新日期:1998-12-12 00:00:00
abstract:OBJECTIVE:To examine whether the association of inadequate or unclear allocation concealment and lack of blinding with biased estimates of intervention effects varies with the nature of the intervention or outcome. DESIGN:Combined analysis of data from three meta-epidemiological studies based on collections of meta-an...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.39465.451748.AD
更新日期:2008-03-15 00:00:00
abstract:OBJECTIVE:To study the processes involved in and impact of mergers between NHS trusts, including the effect on management costs. DESIGN:Cross sectional study involving in depth interviews and documentary analysis; case study to compare savings in management costs between case trusts and control trusts. SETTING:Nine t...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
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更新日期:2002-08-03 00:00:00
abstract:OBJECTIVE:To determine the effectiveness of oral rehydration in children with moderate dehydration caused by gastroenteritis, and to compare the complications of oral and intravenous treatment. DESIGN:Randomised controlled trial. SETTING:Emergency department and infectious diseases ward in a large urban teaching hosp...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.303.6799.393
更新日期:1991-08-17 00:00:00
abstract:OBJECTIVE:To evaluate the primary care communications initiative, which introduced NHSnet to primary care in Scotland. DESIGN:Semi-structured telephone interviews, postal questionnaire. SETTING:All 15 Scottish health boards, random sample of 1 in 3 of all Scottish general practices. PARTICIPANTS:Information manageme...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.321.7265.878
更新日期:2000-10-07 00:00:00
abstract::The instrument through which a commissioner purchases health services from a provider is, as in other walks of life, a contract, so considerable importance has been attached by the NHS Executive to the contracting mechanism. A contract should in theory influence the quality of the service provided, but they are in man...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7055.477
更新日期:1996-08-24 00:00:00
abstract:OBJECTIVE:To determine if trimethoprim use for urinary tract infection (UTI) is associated with an increased risk of acute kidney injury, hyperkalaemia, or sudden death in the general population. DESIGN:Cohort study. SETTING:UK electronic primary care records from practices contributing to the Clinical Practice Resea...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.k341
更新日期:2018-02-09 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.312.7042.1340
更新日期:1996-05-25 00:00:00
abstract:OBJECTIVES:To examine how insurance companies assess proposals for life assurance from applicants with raised cholesterol concentrations and to determine the excess mortality rating applied. DESIGN:Survey of 49 companies underwriting term life assurance. SETTING:United Kingdom. SUBJECTS:Four fictional men aged 30 se...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.302.6781.891
更新日期:1991-04-13 00:00:00
abstract:OBJECTIVE:To compare health behaviours during pregnancy (smoking and alcohol consumption) and after birth (initiation and duration of breast feeding) between British/Irish white mothers and mothers from ethnic minority groups; and, in mothers from ethnic minority groups, to examine whether indicators of acculturation (...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.39532.688877.25
更新日期:2008-05-10 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.l4151
更新日期:2019-07-10 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.c4990
更新日期:2010-10-06 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.303.6806.813
更新日期:1991-10-05 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.h4263
更新日期:2015-10-21 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.310.6990.1315
更新日期:1995-05-20 00:00:00
abstract:OBJECTIVES:To compare "hospital at home" and hospital care as an inpatient in acute exacerbations of chronic obstructive pulmonary disease. DESIGN:Prospective randomised controlled trial with three months' follow up. SETTING:University teaching hospital offering secondary care service to 350 000 patients. PATIENTS:S...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.321.7271.1265
更新日期:2000-11-18 00:00:00
abstract:OBJECTIVE:To appraise a new method of prenatal screening for Down's syndrome based on maternal serum concentrations of alpha fetoprotein, unconjugated oestriol, and human chorionic gonadotrophin combined with maternal age--the "triple test." DESIGN:Examination of the cost effectiveness of the triple test relative to s...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.302.6785.1133
更新日期:1991-05-11 00:00:00
abstract:OBJECTIVE:To gain detailed understanding of influences on smoking behaviour in Bangladeshi and Pakistani communities in the United Kingdom to inform the development of effective and culturally acceptable smoking cessation interventions. DESIGN:Qualitative study using community participatory methods, purposeful samplin...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.326.7396.962
更新日期:2003-05-03 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.322.7297.1277
更新日期:2001-05-26 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.e3086
更新日期:2012-05-15 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.311.7000.297
更新日期:1995-07-29 00:00:00
abstract::A doctor who performed an abortion in Poland faces two years in prison and the loss of his medical license for up to 10 years if he is found guilty of violating the new abortion laws introduced in 1993 after a lengthy campaign by the Catholic church and the Christian Democratic Union party. The new laws permit aborti...
journal_title:BMJ (Clinical research ed.)
pub_type: 新闻
doi:10.1136/bmj.310.6994.1556a
更新日期:1995-06-17 00:00:00