Mayor, S. |2020| Lung cancer: CT screening in former or current smokers significantly reduces mortality, study finds| BMJ |368 |doi: https://doi.org/10.1136/bmj.m347
The findings of a large randomised controlled trial, now published in the NEJM, demonstrate that regular computed tomographic (CT) screening in current and former smokers reduces lung cancer mortality by around a quarter at 10 years.
The NELSON study included more than 13 000 men and 2 500 women aged between 50 and 74 from the Netherlands and Belgium. All of the subjects were current or former smokers, with a median smoking history of 38.0 pack years (interquartile range 29.7 pack years to 49.5 pack years) among male participants. Less than half (44.9%) of the men in the study were former smokers.
Results showed that deaths from lung cancer were nearly a quarter (24%) lower after 10 years of follow-up in men undergoing regular CT screening than in those not screened . Lung cancer deaths decreased from 3.3 deaths per 1000 person years in the control group to 2.5 deaths per 1000 person years in men who were screened (Source: Mayor, 2020).
There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and current smokers.
A total of 13,195 men (primary analysis) and 2594 women (subgroup analyses) between the ages of 50 and 74 were randomly assigned to undergo CT screening at T0 (baseline), year 1, year 3, and year 5.5 or no screening. We obtained data on cancer diagnosis and the date and cause of death through linkages with national registries in the Netherlands and Belgium, and a review committee confirmed lung cancer as the cause of death when possible. A minimum follow-up of 10 years until December 31, 2015, was completed for all participants.
Among men, the average adherence to CT screening was 90.0%. On average, 9.2% of the screened participants underwent at least one additional CT scan (initially indeterminate). The overall referral rate for suspicious nodules was 2.1%. At 10 years of follow-up, the incidence of lung cancer was 5.58 cases per 1000 person-years in the screening group and 4.91 cases per 1000 person-years in the control group; lung-cancer mortality was 2.50 deaths per 1000 person-years and 3.30 deaths per 1000 person-years, respectively. The cumulative rate ratio for death from lung cancer at 10 years was 0.76 in the screening group as compared with the control group, similar to the values at years 8 and 9. Among women, the rate ratio was 0.67 at 10 years of follow-up, with values of 0.41 to 0.52 in years 7 through 9.
In this trial involving high-risk persons, lung-cancer mortality was significantly lower among those who underwent volume CT screening than among those who underwent no screening. There were low rates of follow-up procedures for results suggestive of lung cancer. (Funded by the Netherlands Organization of Health Research and Development and others; NELSON Netherlands Trial Register number, NL580. opens in new tab.)
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