Lung cancer screening with low-dose helical CT: results from the National Lung Screening Trial (NLST)
Journal of Medical ScreeningPublished 1 September 2011Open access
Barnett S. Kramer, Christine D. Berg, Denise R. Aberle, Philip C. Prorok
Citations165
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Results from the first large-scale randomized controlled trial ever to show a reduction in lung cancer mortality associated with screening were announced to the public last November 4, and the story behind this historical first is informative.
Keywords
Medicine
The LancetEarly Lung Cancer Action Project: overall design and findings from baseline screening
2,512 Citations1999Claudia I. Henschke, Dorothy I. McCauley +9 more
Low-dose CT can greatly improve the likelihood of detection of small non-calcified nodules, and thus of lung cancer at an earlier and potentially more curable stage, although false-positive CT results are common.
Archives of Internal MedicineRadiation Dose Associated With Common Computed Tomography Examinations and the Associated Lifetime Attributable Risk of Cancer
2,460 Citations2009Rebecca Smith‐Bindman
Radiation doses from commonly performed diagnostic CT examinations are higher and more variable than generally quoted, highlighting the need for greater standardization across institutions.
Archives of Internal MedicineProjected Cancer Risks From Computed Tomographic Scans Performed in the United States in 2007
1,877 Citations2009Amy Berrington de González
These detailed estimates highlight several areas of CT scan use that make large contributions to the total cancer risk, including several scan types and age groups with a high frequency of use or scans involving relatively high doses, in which risk-reduction efforts may be warranted.
New England Journal of MedicineExposure to Low-Dose Ionizing Radiation from Medical Imaging Procedures
1,327 Citations2009Reza Fazel, Harlan M. Krumholz +8 more
Imaging procedures are an important source of exposure to ionizing radiation in the United States and can result in high cumulative effective doses of radiation, which increased with advancing age and were higher in women than in men.
RadiologyThe National Lung Screening Trial: Overview and Study Design
1,238 Citations2010Constantine A. Gatsonis, Denise R. Aberle +18 more
The National Lung Screening Trial (NLST) is a randomized multicenter study comparing low-dose helical computed tomography with chest radiography in the screening of older current and former heavy smokers for early detection of lung cancer.
American Journal of Respiratory and Critical Care MedicineScreening for Lung Cancer with Low-Dose Spiral Computed Tomography
687 Citations2002Stephen J. Swensen, James R. Jett +11 more
JAMAComputed Tomography Screening and Lung Cancer Outcomes
569 Citations2007Peter B. Bach
Screening for lung cancer with low-dose CT may increase the rate of lung cancer diagnosis and treatment, but may not meaningfully reduce the risk of advanced lung cancer or death from lung cancer.
Controlled Clinical TrialsThe Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial of the National Cancer Institute: History, organization, and status
549 Citations2000John K. Gohagan, Philip C. Prorok +2 more
The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial is enrolling 148,000 men and women ages 55-74 at ten screening centers nationwide with balanced randomization to intervention and control arms to assess health status and cause of death.
JNCI Journal of the National Cancer InstituteLung Cancer Mortality in the Mayo Lung Project: Impact of Extended Follow-up
526 Citations2000P. M. Marcus, Erik J. Bergstralh +5 more
Extended follow-up of MLP participants did not reveal a lung cancer mortality reduction for the intervention arm, which indicates that some lesions with limited clinical relevance may have been identified in the Intervention arm.
RadiologyScreening for Early Lung Cancer with Low-Dose Spiral CT: Prevalence in 817 Asymptomatic Smokers
504 Citations2002Stefan Diederich, Dag Wormanns +5 more
Lung cancer screening with low-dose CT demonstrated a prevalence of asymptomatic cancers in 1.3% of a smoking population, including a high proportion of early tumor stages and a 20% rate of invasive procedures for benign lesions.
British Journal of CancerResults of three-year mass screening programme for lung cancer using mobile low-dose spiral computed tomography scanner
499 Citations2001S Sone, F Li +9 more
This trial allowed detection of nearly 11 times the expected annual number of early lung cancers, compared to those in the initial screening, and repeat CT allowed the detection of more aggressive, rapidly growing lung cancers.
CancerEarly Lung Cancer Action Project
487 Citations2001Claudia I. Henschke, David P. Naidich +11 more
The Early Lung Cancer Action Project (ELCAP) was designed to evaluate the usefulness of annual CT screening for lung carcinoma, and the focus of the current study was on the early results of the repeat screenings.
PubMedEarly lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Johns Hopkins study.
453 Citations1984Frost Jk, Ball Wc +8 more
Screening by sputum cytology was found to improve the detection only of squamous cell carcinoma, and screening by both roentgenography and cytology identified a greater proportion of the lung cancer cases at an earlier stage.
New England Journal of MedicineIs Computed Tomography Safe?
444 Citations2010Rebecca Smith‐Bindman
Dr. Rebecca Smith-Bindman writes that the risk of cancer from a single CT scan could be as high as 1 in 80 — unacceptably high, given the capacity to reduce these doses of radiation.
Journal of Thoracic OncologyThe Danish Randomized Lung Cancer CT Screening Trial—Overall Design and Results of the Prevalence Round
438 Citations2009Jesper Holst Pedersen, Haseem Ashraf +12 more
Screening with low dose computed tomography may facilitate minimal invasive treatment and can be performed with a relatively low rate of false-positive screen results compared with previous studies on lung cancer screening.
PubMedEarly lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo Clinic study.
423 Citations1984R Fontana, David Sanderson +5 more
The initial (prevalence) radiologic and cytologic screening for lung cancer in the Mayo Clinic study (Mayo Lung Project) involved 10,933 outpatients, and the prevalence cancers were more than twice as likely to be resectable, postsurgical Stage I or II (AJCC), and associated with survival 5 yr after treatment.
Journal of Clinical OncologyScreening for Lung Cancer With Low-Dose Helical Computed Tomography: Anti-Lung Cancer Association Project
421 Citations2002Tomotaka Sobue, Noriyuki Moriyama +10 more
CancerScreening for lung cancer. A critique of the mayo lung project
386 Citations1991Robert S. Fontana, David Sanderson +8 more
Results do not justify recommending large‐scale radiologic or cytologic screening for early lung cancer at this time, and the statistical power of these trials was somewhat limited.
American Journal of Respiratory and Critical Care MedicineA Randomized Study of Lung Cancer Screening with Spiral Computed Tomography
379 Citations2009Maurizio Infante, Silvio Cavuto +18 more
The mortality benefit from lung cancer screening by LDCT might be far smaller than anticipated.
JAMALung Cancer Screening With Helical Computed Tomography in Older Adult Smokers
319 Citations2003Parthiv J. Mahadevia, Lee A. Fleisher +4 more
Even if efficacy is eventually proven, screening must overcome multiple additional barriers to be highly cost-effective for any of the cohorts and direct-to-consumer marketing of helical CT is not advisable.
CHEST JournalLung Cancer Screening Using Low-Dose Spiral CT
318 Citations2002Takeshi Nawa, Tohru Nakagawa +4 more
Low-dose spiral CT seems to be a promising method for screening early lung cancer as a part of annual health examinations, and female and nonsmoking subjects should be included in the baseline screening.
Lung CancerFinal results of the Lung Screening Study, a randomized feasibility study of spiral CT versus chest X-ray screening for lung cancer
302 Citations2004John K. Gohagan, Pamela M. Marcus +35 more
The Lung Screening Study has established the feasibility of a RCT comparing annual spiral CT to chest X-ray for lung cancer screening, and the findings at the year one screen are reported.
Lung CancerDesign, recruitment and baseline results of the ITALUNG trial for lung cancer screening with low-dose CT
290 Citations2008Andrea Lopes Pegna, Giulia Picozzi +10 more
Recruitment by mail of high risk subjects for a lung cancer screening RCT is feasible but not efficient and results of the baseline screening test in the active arm of the ITALUNG trial are substantially in line with those of RCT and observational studies.
CancerLung cancer detection results of a randomized prospective study in Czechoslovakia
290 Citations1986A Kubík, J Polák
The study confirmed the ability of radiologic screening to detect lung cancer at an earlier stage when treatment by resection can be accomplished and the absolute numbers of 5‐year survivors detected by screening were practically the same for either compared screening frequency.
CHEST JournalBaseline Findings of a Randomized Feasibility Trial of Lung Cancer Screening With Spiral CT Scan vs Chest Radiograph
280 Citations2004John K. Gohagan, Pamela M. Marcus +4 more
The results of the LSS demonstrated convincingly the feasibility of an RCT of LDCT scanning in the United States.
CHEST JournalSurvival and Mortality from Lung Cancer in a Screened Population
276 Citations1986Melvyn S. Tockman
PubMedEarly lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Memorial Sloan-Kettering study.
267 Citations1984Betty J. Flehinger, M R Melamed +4 more
This is a report of the initial (prevalence) screening for lung cancer in a population of 10.040 cigarette-smoking men 45 yr of age and older, recruited from metropolitan New York, and approximately half the men, randomly chosen, also had sputum cytology (dual screen).
ThoraxUK Lung Screen (UKLS) nodule management protocol: modelling of a single screen randomised controlled trial of low-dose CT screening for lung cancer
226 Citations2011David Baldwin, Stephen W. Duffy +4 more
The modelling of nodule management in UKLS is described by using volumetric analysis with a single initial screen design and follow-up period of 10 years to result in the development and adoption of the UKLS care pathway, which will be implemented in the planned CT screening trial in the UK.
JNCI Journal of the National Cancer InstituteCancer Risks After Radiation Exposure in Middle Age
179 Citations2010Igor Shuryak, Rainer K. Sachs +1 more
For radiation exposure in middle age, most radiation-induced cancer risks do not, as often assumed, decrease with increasing age at exposure, which suggests that promotional processes in radiation carcinogenesis become increasingly important as the age at Exposure increases.
British Journal of CancerShort-term health-related quality of life consequences in a lung cancer CT screening trial (NELSON)
171 Citations2009Karien A.M. van den Bergh, Marie‐Louise Essink‐Bot +5 more
This longitudinal study among participants of a lung cancer screening programme showed that in the short term recipients of an indeterminate result experienced increased lung-cancer-specific distress, whereas the HRQoL changes after a negative baseline screening result may be interpreted as a relief.
The Annals of Family MedicineCumulative Incidence of False-Positive Results in Repeated, Multimodal Cancer Screening
150 Citations2009Jennifer M. Croswell, Barnett S. Kramer +18 more
For an individual in a multimodal cancer screening trial, the risk of a false-positive finding is about 50% or greater by the 14th test and physicians should educate patients about the likelihood of false positives and resulting diagnostic interventions when counseling about cancer screening.
CancerCzech study on lung cancer screening
108 Citations2000A Kubík, Donald Maxwell Parkin +1 more
An objective of this report is to ascertain whether the cumulative numbers of lung cancer deaths would equalize in the two randomized groups during a prolonged follow‐up period.
CancerLung cancer screening results in the National Cancer Institute New York Study
99 Citations2000Myron R. Melamed
A randomized study was undertaken to evaluate sputum cytology as a lung carcinoma screening technique supplementing the chest X‐ray.
Annual Review of MedicineCancer Screening: The Clash of Science and Intuition
79 Citations2008Barnett S. Kramer, Jennifer M. Croswell
This article explains selection bias, lead-time bias, length-biased sampling, and overdiagnosis in cancer screening, which are counterintuitive concepts with critical implications for early-detection efforts.
CancerThe prostate, lung, colorectal, and ovarian cancer screening trial of the national cancer institute
65 Citations1995John K. Gohagan, Philip C. Prorok +3 more
The two‐year pilot phase of the Prostate, Lung, Colorectal, and Ovarian (PLCO) trial concluded September 29, 1994, and the goals, organization, operation, and recruitment status of the trial are discussed.
Academic RadiologyChest Radiography as the Comparison for Spiral CT in the National Lung Screening Trial
58 Citations2003Timothy R. Church
CancerLung cancer screening results in the National Cancer Institute New York Study
24 Citations2000M R Melamed
Cancer LettersComparison of reduced glutathione with 2-mercaptoethane sulfonate to prevent cyclophosphamide-induced urotoxicity
22 Citations1986Ennio Cavalletti, O. Tofanetti +1 more
In experimentally cyclophosphamide-induced urotoxicity in mice, the protective efficacy and potency of these thiols were similar, suggesting that glutathione may have therapeutic advantages over MESNA because of a wider margin of safety and multiple protective actions displayed by the tripeptide thiol.
Mayo Clinic ProceedingsComputed Tomographic Screening for Lung Cancer: Home Run or Foul Ball?
19 Citations2003Stephen J. Swensen, James R. Jett +2 more
Nature Clinical Practice OncologyCT screening for lung cancer is justified
10 Citations2007Claudia I. Henschke
The evidence for use of spiral CT for lung cancer screening and the results and implications of the International Early Lung Cancer Action Program study are discussed in this Viewpoint.
