The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

National Lung Screening Trial Findings by Age: Medicare-Eligible Versus Under-65 PopulationNational Lung Screening Trial Findings by Age

Paul F. Pinsky, PhD; David S. Gierada, MD; William Hocking, MD; Edward F. Patz Jr., MD; and Barnett S. Kramer, MD, MPH
[+] Article, Author, and Disclosure Information

From the National Cancer Institute, Bethesda, Maryland; Washington University School of Medicine, St. Louis, Missouri; Marshfield Clinic, Marshfield, Wisconsin; and Duke University School of Medicine, Durham, North Carolina.

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, pp4f@nih.gov). 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.

Ann Intern Med. 2014;161(9):627-633. doi:10.7326/M14-1484
Text Size: A A A

Background: 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.

Objective: To examine the results of the NLST LDCT group by age (Medicare-eligible vs. <65 years).

Design: Secondary analysis of a group from a randomized trial (NCT00047385).

Setting: 33 U.S. screening centers.

Patients: 19 612 participants aged 55 to 64 years (under-65 cohort) and 7110 participants aged 65 to 74 years (65+ cohort) at randomization.

Intervention: 3 annual rounds of LDCT screening.

Measurements: Demographics, smoking and medical history, screening examination adherence and results, diagnostic follow-up procedures and complications, lung cancer diagnoses, treatment, survival, and mortality.

Results: 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).

Limitation: The oldest screened patient was aged 76 years.

Conclusion: 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.

Primary Funding Source: National Institutes of Health.


Grahic Jump Location

All-cause survival among patients with screen-detected cancer, by age group.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.