Cary P. Gross, MD
In patients at high risk for lung cancer, does screening with low-dose computed tomography (CT) reduce lung cancer mortality compared with radiographic screening?
Randomized controlled trial (National Lung Screening Trial [NLST]). ClinicalTrials.gov NCT00047385.
Unclear allocation concealment.*
Blinded (cause of death adjudicators).*
Median 6.5 years (up to 7.4 y).
33 clinical centers in the USA.
53 454 patients 55 to 74 years of age (59% men) who had a cigarette smoking history of ≥ 30 pack-years and, if former smokers, had quit within the previous 15 years. Exclusion criteria included previous diagnosis of lung cancer, chest CT within 18 months, hemoptysis, and unexplained weight loss > 6.8 kg (15 lb) in the preceding year.
3 annual screenings, beginning shortly after randomization, with low-dose CT using multidetector scanners with ≥ 4 channels (n = 26 722) or single-view posteroanterior chest radiography (n = 26 732).
Lung cancer mortality. Secondary outcomes included lung-cancer incidence, all-cause mortality, and adverse events.
96% (intention-to-treat analysis).
Adherence to screening was 95% and 93% in the CT and radiography groups, respectively. 24% and 6.9% of CT and radiography screening tests were classified as positive. Of positive tests, 96% and 95% were false positives in the CT and radiography groups. The main results are in the Table. 1.4% of patients in the CT group and 1.6% in the radiology group had ≥ 1 complication after diagnostic evaluation for a positive screening test result.
In patients at high risk for lung cancer, screening with low-dose computed tomography reduced lung cancer mortality compared with radiographic screening.
†Abbreviations defined in Glossary. RRR, RBI, NNT, and CI based on proportions of patients experiencing events reported in article.
Gross CP. Screening with low-dose computed tomography reduced lung cancer mortality in high-risk patients. Ann Intern Med. ;155:JC5–6. doi: 10.7326/0003-4819-155-10-201111150-02006
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Published: Ann Intern Med. 2011;155(10):JC5-6.
Hematology/Oncology, Lung Cancer, Prevention/Screening, Pulmonary/Critical Care.
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