Use of low-dose computed tomography (LDCT) for the detection of lung cancer reduced the rate of death over use of the more traditional chest radiography (CXR), according to the National Lung Screening Trial (NLST). The NSLT found that, with a rate of adherence to screening was more than 90%, LDCT exhibited a positive screening rate of 24.2%, whereas CXR exhibited 6.9%. Both techniques produced a high rate of false positives.
This large, randomized trial enrolled more than 53,000 patients at high risk of lung cancer to undergo 3 annual screenings with either LDCT or CXR. Based on incidence of lung cancer and death, LDCT screening decreased relative mortality from lung cancer by 20.0% compared with CXR (95% CI, 6.8-26.7; P = .004) and the rate of death from any cause by 6.7% (95% CI, 1.2-13.6; P = .02).
The researchers noted, “The reduction in lung-cancer mortality must be weighed against the harms from positive screening results and overdiagnosis, as well as the costs. The benefits, harms, and costs of screening will all depend on the way in which low-dose CT screening is implemented.”
Reactions and Implications
The American Society of Clinical Oncology (ASCO) issued a statement in response to the study, in which the society congratulated the National Cancer Institute for this example of “clinical research at its best.” The ASCO statement pointed out that, although these data are exciting and important, “we must remember that screening is not a substitute for quitting smoking.”
The University of Texas M. D. Anderson Cancer Center also release a statement. This statement, however, shows the impact of the NLST findings. Based on the preliminary findings released this past fall, M. D. Anderson has launched its Lung Cancer Screening Program, which offers a step-by-step program to better detect, treat, and educate high-risk patients against lung cancer. The program offers screening to current or former smokers aged 50 years or older who have smoked the equivalent of one pack per day for at least 20 years. In addition, the program will perform a cost-effective analysis of lung cancer screening, with results expected later this year.
The complete NLST results are available in the July 29, 2011, online edition of The New England Journal of Medicine (http://www.nejm.org/doi/full/10.1056/NEJMoa1102873).
The ASCO press release can be accessed at http://www.asco.org/ASCOv2/Press+Center/Latest+News+Releases/ASCO+Statement+on+Publication+of+the+National+Lung+Screening+Trial+Results/
Information on The M. D. Anderson Lung Cancer Screening Program can be accessed at http://www.mdanderson.org/patient-and-cancer-information/cancer-information/cancer-topics/prevention-and-screening/cancer-screening-guidelines/lung-cancer-screening.html?utm_source=Bronto+at+MD+Anderson&utm_medium=email&utm_term=Cancer+Prevention+Center&utm_content=karen%40greenhillhc.com&utm_campaign=News+Release%3A+UT+MD+Anderson+Debuts+Lung+Cancer+Screening+Program.
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