Efficacy of Chest Radiograph in Comparison to no Intervention in Screening for Lung Cancer in People who Smoke: A Systematic Review

Abstract

Smoking is the primary risk factor for lung cancer, which remains one of the leading causes of cancer-related mortality worldwide. Although chest radiography (CXR) is widely available and inexpensive, its role in lung cancer screening remains uncertain. This systematic review aimed to evaluate the efficacy of chest radiography compared with no screening for the detection of lung cancer, reduction in mortality and morbidity, screening-related harms, and quality of life among individuals who smoke. A systematic search of MEDLINE, Embase, Scopus, and CENTRAL databases was conducted up to June 2025 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PROSPERO registration: CRD42023417365). Randomized controlled trials comparing chest radiography with no screening among current or former smokers were included. Data extraction and quality assessment were independently performed using the Cochrane Risk of Bias 2 tool, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Out of 7977 records identified, one randomized controlled trial, reported in two publications, met the inclusion criteria. Chest radiography demonstrated a lower but statistically nonsignificant rate of lung cancer detection compared with controls (odds ratio OR = 0.50; 95% confidence intervals: 0.09–2.74). Quality-of-life assessments showed a transient decline following the notification of pulmonary nodules. The generalizability of the findings is limited due to the inclusion of only a single eligible study with a small sample size. Overall, current evidence suggests that chest radiography alone does not significantly reduce lung cancer incidence and is insufficient to support its use as an effective standalone screening modality among individuals who smoke.