NLST
Trial question
What is the role of low-dose computed tomographic screening in patients who are at high risk for lung cancer?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
41.0% female
59.0% male
N = 53454
53454 patients (21922 female, 31532 male).
Inclusion criteria: patients who are at high risk for lung cancer.
Key exclusion criteria: previous diagnosis of lung cancer, chest CT within 18 months before enrollment, hemoptysis, or unexplained weight loss > 6.8 kg in the preceding year.
Interventions
N=26722 screening using low-dose CT (use of multidetector scanners with a minimum of four channels, at an average effective dose of 1.5 mSv).
N=26732 screening using CXRs (single-view posteroanterior chest radiography at an average effective dose of 8 mSv).
Primary outcome
Death from any cause
0.07%
0.08%
0.1 %
0.1 %
0.0 %
0.0 %
0.0 %
Screening using low-dose
CT
Screening using chest
X-rays
Significant
decrease ▼
NNT = 10000
Significant decrease in death from any cause (0.07% vs. 0.08%; RR 0.93, 95% CI 0.86 to 0.99).
Secondary outcomes
Significant decrease in the incidence of lung cancer-specific death (247 per 100,000 person-year vs. 309 per 100,000 person-year; RR 0.8, 95% CI 0.73 to 0.93).
Significant increase in the incidence of lung cancer (645 per 100,000 person-year vs. 572 per 100,000 person-year; RR 1.13, 95% CI 1.03 to 1.23).
Conclusion
In patients who are at high risk for lung cancer, screening using low-dose CT was superior to screening using CXRs with respect to death from any cause.
Reference
National Lung Screening Trial Research Team, Aberle DR, Adams AM et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011 Aug 4;365(5):395-409.
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