Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening

By D. R. Aberle, A. M. Adams, Christine D. Berg, William C. Black, J. Clapp, R. Fagerstrom, Ilana F. Gareen, C. Gatsonis, P. Marcus, J. Sicks. New England Journal of Medicine, 2011

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Background The aggressive and heterogeneous nature of lung cancer has thwarted efforts to reduce mortality from this cancer through the use of screening. The advent of low-dose helical computed tomography (CT) altered the landscape of lung-cancer screening, with studies indicating that low-dose CT detects many tumors at early stages. The National Lung Screening Trial (NLST) was conducted to determine whether screening with low-dose CT could reduce mortality from lung cancer. Methods From August 2002 through April 2004, we enrolled 53,454 persons at high risk for lung cancer at 33 U.S. medical centers. Participants were randomly assigned to undergo three annual screenings with either low-dose CT (26,722 participants) or single-view posteroanterior chest radiography (26,732). Data were collected on cases of lung cancer and deaths from lung cancer that occurred through December 31, 2009. Results The rate of adherence to screening was more than 90%. The rate of positive screening tests was 24.2% with low-dose CT and 6.9% with radiography over all three rounds. A total of 96.4% of the positive screening results in the low-dose CT group and 94.5% in the radiography group were false positive results. The incidence of lung cancer was 645 cases per 100,000 person-years (1060 cancers) in the low-dose CT group, as compared with 572 cases per 100,000 person-years (941 cancers) in the radiography group (rate ratio, 1.13; 95% confidence interval [CI], 1.03 to 1.23). There were 247 deaths from lung cancer per 100,000 person-years in the low-dose CT group and 309 deaths per 100,000 person-years in the radiography group, representing a relative reduction in mortality from lung cancer with low-dose CT screening of 20.0% (95% CI, 6.8 to 26.7; P = 0.004). The rate of death from any cause was reduced in the low-dose CT group, as compared with the radiography group, by 6.7% (95% CI, 1.2 to 13.6; P = 0.02). Conclusions Screening with the use of low-dose CT reduces mortality from lung cancer. (Funded by the National Cancer Institute; National Lung Screening Trial ClinicalTrials.gov number, NCT00047385.)

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Citations in the corpus

Cancer statistics, 2015 (2015, unknown): “of earlier detection through screening with spiral computed tomography, which has been shown to reduce lung cancer deaths by 16% to 20% among adults with at least a 30-packyear smoking history.(41,42) However, it is important to realize that screening, as well as other changes in detection practices”
KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation. (2020, methodology): “The National Lung Screening Trial was a large RCT in which current and former smokers were randomized to annual screening for three years with either low-dose CT scans or a chest x-ray.(142) 53,454 individuals aged between 55 – 74 who had a history of cigarette smoking of at least 30 pack-years, and”
Cancer statistics, 2018 (2018, unknown): “There is potential for lung cancer to be diagnosed at an earlier stage among high-risk individuals through the use of screening with low-dose computed tomography (LDCT), which has been shown to reduce lung cancer mortality by up to 20% among current and former smokers with a smoking history of 30 or”
Multi-scale Convolutional Neural Networks for Lung Nodule Classification (2015, background): “Lung cancer is notoriously aggressive with a low long-term survival rate [1].”
Early detection of cancer (2022, background): “For example, the trials assessing lowdose CT screening for lung cancer in heavy smokers took 7 years and 53,454 participants in the US (123) and more than 10 years with 15,789 participants in Europe (124).”
RadImageNet: An Open Radiologic Deep Learning Research Dataset for Effective Transfer Learning (2022, background): “The Cancer Imaging Archive (6) contains a large database of national lung screening trials, which consists of low-dose helical CT images in 53 454 participants (7).”