Lung Cancer Screening: Simulations of Effects of Imperfect Detection on Temporal Dynamics

PURPOSE: To use a mathematic model to demonstrate effects of imperfect detection on temporal dynamics of radiologic lung cancer screening.

MATERIALS AND METHODS: Monte Carlo simulations of lung cancer screening programs were performed in subjects at high risk for developing cancer. The effects of detection probabilities, symptomatic presentation of tumors, tumor volume doubling time, and time between screenings were examined. Computed tomography (CT) and chest radiography models were used.

RESULTS: For imperfect detection probabilities, the percentage of subjects with cancers detected with repeated screenings decreased to a steady-state value. The transition period was the period during which screenings were performed and detection rates decreased. At steady-state repeat screening, the proportion of subjects with cancers diagnosed at screening or by means of symptomatic presentation was determined by the annual probability of developing cancer and not by the sensitivity of the screening modality. The sensitivity of the screening technique did affect detected cancer size, number of interval cancers, and total number of cancers observed. CT was used to detect more total cancers over the course of the screening program and cancers with a smaller average size; moreover, fewer interval cancers were observed with CT screening than with chest radiography screening.

CONCLUSION: Lung cancer screening with imperfect detection has a transition period between baseline screening and steady-state behavior of annual screenings. Advantages of CT screening include a decrease in the average cancer size at detection, a decrease in the number of observed interval cancers, and an increase in the total number of cancers observed. Steady-state behavior indicates that long-term trials of screening may not be necessary.

© RSNA, 2005


  • 1 Levi F, Lucchini F, Negri E, La Vecchia C. Worldwide patterns of cancer mortality, 1990–1994. Eur J Cancer Prev 1999; 8:381-400. Crossref, MedlineGoogle Scholar
  • 2 Petty TL. Screening strategies for early detection of lung cancer: the time is now. JAMA 2000; 284:1977-1980. Crossref, MedlineGoogle Scholar
  • 3 Henschke CI, Miettienen OS, Yankelevitz DF, Libby DM, Smith JP. Radiographic screening for cancer: proposed paradigm for requisite research. Clin Imaging 1994; 18:16-20. Crossref, MedlineGoogle Scholar
  • 4 Sone S, Takashima S, Li F, et al. Mass screening for lung cancer with mobile spiral computed tomography scanner. Lancet 1998; 351:1242-1245. Crossref, MedlineGoogle Scholar
  • 5 Fontana RS, Sanderson DR, Woolner LB, et al. Screening for lung cancer: a critique of the Mayo Lung Project. Cancer 1991; 67:1155-1164. Crossref, MedlineGoogle Scholar
  • 6 Soda H, Tomita H, Kohno S, Oka M. Limitation of annual screening chest radiography for the diagnosis of lung cancer. Cancer 1993; 72:2341-2346. Crossref, MedlineGoogle Scholar
  • 7 Li F, Sone S, Abe H, MacMahon H, Armato SG, 3rd, Doi K. Lung cancers missed at low-dose helical CT screening in a general population: comparison of clinical, histopathologic, and imaging findings. Radiology 2002; 225:673-683. LinkGoogle Scholar
  • 8 Kaneko M, Eguchi K, Ohmatsu H, et al. Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography. Radiology 1996; 201:798-802. LinkGoogle Scholar
  • 9 Henschke CI, McCauley DI, Yankelevitz DF, et al. Early lung cancer action project: overall design and findings from baseline screening. Lancet 1999; 354:99-105. Crossref, MedlineGoogle Scholar
  • 10 Sone S, Li F, Yang ZG, et al. Characteristics of small lung cancers invisible on conventional chest radiography and detected by population based screening using spiral CT. Br J Radiol 2000; 73:137-145. Crossref, MedlineGoogle Scholar
  • 11 Sone S, Li F, Yang ZG, et al. Results of 3-year mass screening programme for lung cancer using mobile low-dose spiral computed tomography scanner. Br J Cancer 2001; 84:25-32. Crossref, MedlineGoogle Scholar
  • 12 Boiselle PM, Ernst A, Karp DD. Lung cancer detection in the 21st century: potential contributions and challenges of emerging technologies. AJR Am J Roentgenol 2000; 175:1215-1221. Crossref, MedlineGoogle Scholar
  • 13 Henschke CI, Yankelevitz DF, Naidich DP, et al. CT screening for lung cancer: suspiciousness of nodules according to size on baseline scans. Radiology 2004; 231:164-168. LinkGoogle Scholar
  • 14 Zelen M, Feinleib M. On the theory of screening for chronic disease. Biometrika 1969; 56:601-614. CrossrefGoogle Scholar
  • 15 Shapiro S, Goldberg JD, Hutchinson GB. Lead time in breast cancer detection and implications for periodicity of screening. Am J Epidemiol 1974; 100:357-366. Crossref, MedlineGoogle Scholar
  • 16 Flehinger BJ, Kimmel M. The natural history of lung cancer in a periodically screened population. Biometrics 1987; 43:127-144. Crossref, MedlineGoogle Scholar
  • 17 Henschke CI, Naidich DP, Yankelevitz DF, et al. Early lung cancer action project: initial findings on repeat screening. Cancer 2001; 92:153-159. Crossref, MedlineGoogle Scholar
  • 18 Vander AJ, Sherman JH, Luciano DS. Human physiology: the mechanisms of body function 6th ed. New York, NY: McGraw-Hill, 1994; 40. Google Scholar
  • 19 Hasegawa M, Sone S, Takashima S, et al. Growth rate of small lung cancers detected on mass CT screening. Br J Radiol 2000; 73:1252-1259. Crossref, MedlineGoogle Scholar
  • 20 Usuda K, Saito Y, Sagawa M, et al. Tumor doubling time and prognostic assessment of patients with primary lung cancer. Cancer 1994; 74:2239-2244. Crossref, MedlineGoogle Scholar
  • 21 Yankelevitz DF, Kostis WJ, Henschke CI, et al. Overdiagnosis in chest radiographic screening for lung carcinoma: frequency. Cancer 2003; 97:1271-1275. Crossref, MedlineGoogle Scholar
  • 22 Heelan RT, Flehinger BJ, Melamed MR, et al. Non-small-cell lung cancer: results of the New York Screening Program. Radiology 1984; 151:289-293. LinkGoogle Scholar
  • 23 Frenzen CL, Murray JD. A cell kinetics justification for Gompertz’ equation. SIAM J Appl Math 1986; 46:614-629. CrossrefGoogle Scholar
  • 24 Castro MA, Klamt F, Grienseisen VA, Grivicich I, Moreira JC. Gompertzian growth pattern correlated with phenotypic organization of colon carcinoma, malignant glioma and non-small cell lung carcinoma cell lines. Cell Prolif 2003; 36:65-73. Crossref, MedlineGoogle Scholar
  • 25 Calderón CP, Kwembe TA. Modeling tumor growth. Math Biosci 1991; 103:97-114. Crossref, MedlineGoogle Scholar
  • 26 Eddy DM. Screening for lung cancer. Ann Intern Med 1989; 111:232-237. Crossref, MedlineGoogle Scholar
  • 27 Hillman BJ. CT screening: who benefits and who pays. Radiology 2003; 228:26-28. LinkGoogle Scholar
  • 28 Mahadevia PJ, Fleisher LA, Frick KD, Eng J, Goodman SN, Powe NR. Lung cancer screening with helical computed tomography in older adult smokers: a decision and cost-effectiveness analysis. JAMA 2003; 289:313-322. Crossref, MedlineGoogle Scholar
  • 29 Wisnivesky JP, Mushlin AI, Sicherman N, Henschke C. The cost-effectiveness of low-dose CT screening for lung cancer. Chest 2003; 124:614-621. Crossref, MedlineGoogle Scholar

Article History

Published in print: Feb 2005