Paul F. Pinsky, PhD; David S. Gierada, MD; William Hocking, MD; Edward F. Patz Jr., MD; Barnett S. Kramer, MD, MPH
Grant Support: By the National Institutes of Health (U01-CA-80098, U01-CA-79778, N01-CN-25522, N01-CN-25511, N01-CN-25512, N01-CN-25513, N01-CN-25514, N01-CN-25515, N01-CN-25516, N01-CN-25518, N01-CN-25524, N01-CN-75022, N01-CN-25476, and N02-CN-63300).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1484.
Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Pinsky (e-mail, email@example.com). Data set: Available upon request at https://biometry.nci.nih.gov/cdas.
Requests for Single Reprints: Paul F. Pinsky, PhD, National Cancer Institute, 9609 Medical Center Drive, Room 5E108, Bethesda, MD 20892.
Current Author Addresses: Drs. Pinsky and Kramer: National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892.
Dr. Gierada: Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO 63110.
Dr. Hocking: Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI 54449.
Dr. Patz: Duke University School of Medicine, 1515B Hosp North, Durham, NC 27710.
Author Contributions: Conception and design: P.F. Pinsky, D.S. Gierada, E.F. Patz.
Analysis and interpretation of the data: P.F. Pinsky, D.S. Gierada, W. Hocking, E.F. Patz, B.S. Kramer.
Drafting of the article: P.F. Pinsky, W. Hocking, E.F. Patz.
Critical revision of the article for important intellectual content: P.F. Pinsky, D.S. Gierada, W. Hocking, E.F. Patz, B.S. Kramer.
Final approval of the article: P.F. Pinsky, D.S. Gierada, W. Hocking, E.F. Patz, B.S. Kramer.
Provision of study materials or patients: W. Hocking.
Statistical expertise: P.F. Pinsky.
Obtaining of funding: W. Hocking.
Collection and assembly of data: D.S. Gierada, W. Hocking.
The NLST (National Lung Screening Trial) showed reduced lung cancer mortality in high-risk participants (smoking history of ≥30 pack-years) aged 55 to 74 years who were randomly assigned to screening with low-dose computed tomography (LDCT) versus those assigned to chest radiography. An advisory panel recently expressed reservations about Medicare coverage of LDCT screening because of concerns about performance in the Medicare-aged population, which accounted for only 25% of the NLST participants.
To examine the results of the NLST LDCT group by age (Medicare-eligible vs. <65 years).
Secondary analysis of a group from a randomized trial (NCT00047385).
33 U.S. screening centers.
19 612 participants aged 55 to 64 years (under-65 cohort) and 7110 participants aged 65 to 74 years (65+ cohort) at randomization.
3 annual rounds of LDCT screening.
Demographics, smoking and medical history, screening examination adherence and results, diagnostic follow-up procedures and complications, lung cancer diagnoses, treatment, survival, and mortality.
The aggregate false-positive rate was higher in the 65+ cohort than in the under-65 cohort (27.7% vs. 22.0%; P < 0.001). Invasive diagnostic procedures after false-positive screening results were modestly more frequent in the older cohort (3.3% vs. 2.7%; P = 0.039). Complications from invasive procedures were low in both groups (9.8% in the under-65 cohort vs. 8.5% in the 65+ cohort). Prevalence and positive predictive value (PPV) were higher in the 65+ cohort (PPV, 4.9% vs. 3.0%). Resection rates for screen-detected cancer were similar (75.6% in the under-65 cohort vs. 73.2% in the 65+ cohort). Five-year all-cause survival was lower in the 65+ cohort (55.1% vs. 64.1%; P = 0.018).
The oldest screened patient was aged 76 years.
NLST participants aged 65 years or older had a higher rate of false-positive screening results than those younger than 65 years but a higher cancer prevalence and PPV. Screen-detected cancer was treated similarly in the groups.
National Institutes of Health.
Paul F. Pinsky, David S. Gierada, William Hocking, Edward F. Patz, Barnett S. Kramer. National Lung Screening Trial Findings by Age: Medicare-Eligible Versus Under-65 Population. Ann Intern Med. 2014;161:627–633. doi: 10.7326/M14-1484
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Published: Ann Intern Med. 2014;161(9):627-633.
Cancer Screening/Prevention, Healthcare Delivery and Policy, Hematology/Oncology, Lung Cancer, Pulmonary/Critical Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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