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Abstract
The aggressive and heterogeneous nature of lung cancer has thwarted efforts to reduce
mortality from this cancer through the use of screening. The advent of low-dose helical
computed tomography (CT) altered the landscape of lung-cancer screening, with studies
indicating that low-dose CT detects many tumors at early stages. The National Lung
Screening Trial (NLST) was conducted to determine whether screening with low-dose
CT could reduce mortality from lung cancer.
From August 2002 through April 2004, we enrolled 53,454 persons at high risk for lung
cancer at 33 U.S. medical centers. Participants were randomly assigned to undergo
three annual screenings with either low-dose CT (26,722 participants) or single-view
posteroanterior chest radiography (26,732). Data were collected on cases of lung cancer
and deaths from lung cancer that occurred through December 31, 2009.
The rate of adherence to screening was more than 90%. The rate of positive screening
tests was 24.2% with low-dose CT and 6.9% with radiography over all three rounds.
A total of 96.4% of the positive screening results in the low-dose CT group and 94.5%
in the radiography group were false positive results. The incidence of lung cancer
was 645 cases per 100,000 person-years (1060 cancers) in the low-dose CT group, as
compared with 572 cases per 100,000 person-years (941 cancers) in the radiography
group (rate ratio, 1.13; 95% confidence interval [CI], 1.03 to 1.23). There were 247
deaths from lung cancer per 100,000 person-years in the low-dose CT group and 309
deaths per 100,000 person-years in the radiography group, representing a relative
reduction in mortality from lung cancer with low-dose CT screening of 20.0% (95% CI,
6.8 to 26.7; P=0.004). The rate of death from any cause was reduced in the low-dose
CT group, as compared with the radiography group, by 6.7% (95% CI, 1.2 to 13.6; P=0.02).
Screening with the use of low-dose CT reduces mortality from lung cancer. (Funded
by the National Cancer Institute; National Lung Screening Trial ClinicalTrials.gov
number, NCT00047385.).