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Decision support tools for lung cancer screening

Philippe GUILLOU and Pierre MESSMER

By 2025, lung cancer was the leading cause of cancer death worldwide. By 2021, only the USA, China and South Korea were offering organized screening for bronchopulmonary cancer using low-dose lung CT. In France, by 2025, a national research program is evaluating the criteria for organized screening (age, frequency, etc.). Participation in screening is based on a shared decision. The use of decision-support tools promotes this process by reducing decision-making conflict.The main objective of this study was to describe the population included in screening, and the benefits and risks used in existing decision-support tools.This review was recorded on Prospero. A systematic literature review was conducted according to PRISMA 2020 criteria by two researchers. The search was carried out on PubMed® and Google® (gray literature) between 2014 and 2024.Out of 700 articles identified, twenty decision-support tools were included. The majority came from the United States. Eligibility criteria for screening were mainly age between 55 and 80, smoker or former smoker of less than 15 years, with at least 30 pack years of smoking exposure. The quantitative benefit most used was: 3 deaths avoided out of 1000 people screened (18 versus 21) with annual screening for 3 years. The most frequently used limitation was the false-positive rate. The most common rate was 365 false positives per 1000 people after 3 years of screening, resulting in 25 invasive procedures, including 3 major complications.There was heterogeneity in the data presented in these tools in terms of benefits and risks. The presentation of a risk modifies its perception. Use of the Number Needed to Screen (304 in the NLST trial) was rare.This review provides an overview of the different contents used in existing tools, which could serve as a basis for the development of a French tool.