Mortality Benefits of CT Screening for Lung Cancer in High-Risk Persons
Posted: Monday, February 10, 2020
Lung cancer mortality is significantly lower in high-risk former and current smokers who underwent volume-based, low-dose computed tomography (CT) screening compared with those who did not undergo screening, according to the findings of the NELSON trial. Harry J. de Koning, MD, PhD, of the University of Erasmus in Rotterdam, and colleagues noted that volume CT screening reduced false-positive test results as well as unnecessary workup procedures without apparently jeopardizing favorable outcomes. These results were published in The New England Journal of Medicine.
“Volume CT lung-cancer screening of high-risk former and current smokers, with the introduction of growth-rate assessment as an imaging biomarker for indeterminate tests, resulted in low referral rates for additional assessments and substantially lower lung-cancer mortality (in both sexes) than no screening, despite screening intervals that increased over time,” concluded the authors.
This study enrolled a total of 13,195 men and 2,594 women between the ages of 50 and 74 who were randomly assigned to receive CT screening or not. Patients who were screened received CT scans at baseline, year 1, year 3, and year 5.5. Data on cancer diagnoses, date, and cause of death were obtained from national registries in the Netherlands and Belgium. All patients were followed for a minimum of 10 years.
The incidence of lung cancer was 5.58 cases per 1,000 person-years in the screening group and 4.91 cases per 1,000 person-years in the control group at 10 years of follow-up. The mortality from lung cancer was 2.50 deaths per 1,000 person-years in the screening group and 3.30 deaths per 1,000 person-years in the control group. The cumulative rate ratio for death at 10 years was 0.76 for the screening group compared with the control group in men. This value was similar at 8 and 9 years as well. Women had a rate ratio of 0.67 at 10 years, 0.41 at 7 years, and 0.52 at 9 years of follow-up.
Disclosure: For full author disclosures, visit www.nejm.org.