"National Lung Screening Trial (NLST)". The New England Journal of Medicine. 2011.
Links to original sources: Wiki Journal Post Full Journal Article
Contents
1. Clinical Question 2. Bottom Line 3. Major Points 4. Guidelines 5. Design 6. Population 6.1 Inclusion Criteria 6.2 Exclusion Criteria 6.3 Baseline Characteristics 7. Interventions 8. Outcomes 8.1 Primary Outcome 8.2 Secondary Outcomes 9. Criticisms 10. Funding 11. Further Reading
Does screening with low-dose computed tomography (CT) reduce mortality from lung cancer?
Screening with low-dose CT in persons at high risk for lung cancer results in a significant reduction in lung cancer mortality compared to screening with chest radiography.
The NLST trial compared the effectiveness of low-dose CT with chest radiography in reducing lung cancer mortality among high-risk individuals. Findings demonstrated a 20% relative reduction in lung cancer mortality with low-dose CT screening, which suggests that this screening modality can be beneficial in carefully selected patients.
To be developed following analysis of the NLST and other trials' data, considering cost-effectiveness, harms from positive screening results and overdiagnosis, and competing interventions like smoking cessation.
Multicenter, randomized, controlled trial involving 53,454 participants considered at high risk for lung cancer who were randomized to three annual screenings with either low-dose CT or single-view posteroanterior chest radiography.
Participants were aged 55-74, had a history of cigarette smoking of at least 30 pack-years, and, if former smokers, had quit within the previous 15 years.
Inclusion Criteria - Ages 55-74 at the time of randomization - History of tobacco smoking of at least 30 pack-years - If former smokers, cessation of smoking within the past 15 years
Exclusion Criteria - Previous lung cancer diagnosis - Chest CT within 18 months prior to enrollment - Hemoptysis or unexplained weight loss over 15 pounds in the preceding year
Baseline Characteristics Participants were demographically similar, approximately 94% former or current smokers, generally reflecting a "healthy-volunteer" effect.
Participants were randomized to three annual screenings with either low-dose CT or single-view posteroanterior chest radiography.
Primary Outcome A 20% relative reduction in mortality from lung cancer was seen with low-dose CT screening. The number needed to screen to prevent one death from lung cancer was 320.
Overall mortality was reduced by 6.7% in the low-dose CT group. There was a high rate of false positive results in both groups, but these mostly stemmed from benign findings.
- The “healthy-volunteer” effect may have biased results more favorably than in the community setting. - Technological advancements in CT imaging may alter the effectiveness of screening. - Trial conducted at expert centers, so results may not generalize to community facilities. - Reduction in lung cancer mortality may differ with ongoing screening regimens beyond the three rounds of NLST. - Potential harms include overdiagnosis and radiation exposure.
Supported by grants from the National Cancer Institute (NCI) for both the ACRIN and the Lung Screening Study sites of the NLST.
- Full text of the article - Supplementary appendix and materials