The New England Journal of Medicine. 2011.

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

Clinical Question

Does screening with low-dose computed tomography (CT) reduce mortality from lung cancer?

Bottom Line

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.

Major Points

Guidelines

Design

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.

Population

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.

Interventions

Participants were randomized to three annual screenings with either low-dose CT or single-view posteroanterior chest radiography.

Outcomes

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.

Secondary Outcomes
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.

Criticisms

- 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.

- Potential harms include overdiagnosis and radiation exposure.

Funding

Further Reading

- Full text of the article
- Supplementary appendix and materials