{"entity":{"id":"paper-nelson-nejm-2020","kind":"paper","name":"NELSON: volume-based CT screening reduces lung cancer deaths with fewer false alarms","aka":[],"tldr":"In a Dutch-Belgian trial, CT screening using nodule volume rather than diameter cut lung cancer deaths in men by about a quarter at 10 years, with a far lower false-positive rate than NLST.","summary":"NELSON randomised 15,789 current or former smokers (13,195 men and 2,594 women) aged 50-74 to CT screening at baseline, 1, 3 and 5.5 years or to no screening. Nodules were managed by volume and volume-doubling time, with an indeterminate category that triggered a repeat scan rather than a biopsy.\n\nThe primary analysis in men showed a lung cancer mortality rate ratio of 0.76 at 10 years. Screen-detected cancers were much more often stage I. The positive-screen rate was around 2%, far below NLST's, because the indeterminate category absorbed most small nodules.\n\nNELSON confirmed NLST against a no-screening control and gave European programmes a workable protocol.","asOf":"2026-09-08","links":[{"label":"DOI","url":"https://doi.org/10.1056/NEJMoa1911793"},{"label":"NEJM full text","url":"https://www.nejm.org/doi/full/10.1056/NEJMoa1911793"}],"tags":[],"related":["paper-nlst-nejm-2011","idea-prev-lung-screening-risk-model-eligibility","lung-cancer-evidence-roadmap","paper-uspstf-lung-cancer-screening-jama-2021","idea-lung-screening-eligibility-by-risk-not-pack-years"],"cancers":["nsclc","lung-cancer"],"sections":["early-detection"],"technologies":["low-dose-ct-screening","ct","radiology-ai-screening"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["stage-shift","ppv"],"trials":["nlst-nelson"],"people":[],"bottlenecks":["b-early-detection","b-overdiagnosis"],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2020,"doi":"10.1056/NEJMoa1911793","pmid":"31995683","authors":"de Koning HJ, van der Aalst CM, de Jong PA, et al.","paperType":"rct","findings":["Lung cancer mortality rate ratio in men 0.76 (95% CI 0.61-0.94) at 10 years","In the smaller female cohort the rate ratio was 0.67 (95% CI 0.38-1.14), not statistically significant but consistent with benefit","Overall positive-screen rate about 2%, with the majority of screen-detected cancers at stage IA-IB","Comparator was no screening, removing the concern that chest X-ray in NLST masked part of the effect"],"whatItMeans":"Lung screening works when it uses volumetric nodule management, and it works against a no-screening control. The protocol underpins the UK Targeted Lung Health Check programme and European recommendations. Benefit in women remains less precisely estimated.","caveats":["Women were under-represented, so the female estimate is imprecise","Screening intervals lengthened to 2.5 years in the final round; the optimal interval is still debated","Some overdiagnosis is likely; the authors estimated a modest excess of cancers in the screened arm at 10 years","Participants were volunteers responding to a population mailing, which may not reflect routine uptake"],"changedPractice":true,"participants":15789},"route":"/key-papers/paper-nelson-nejm-2020/","neighbours":{"paper":[{"id":"paper-nlst-nejm-2011","kind":"paper","name":"NLST: yearly low-dose CT scans cut lung cancer deaths in heavy smokers","route":"/key-papers/paper-nlst-nejm-2011/"},{"id":"paper-plco-chest-radiograph-lung-cancer-mortality-jama-2011","kind":"paper","name":"Screening by chest radiograph and lung cancer mortality: the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized trial","route":"/key-papers/paper-plco-chest-radiograph-lung-cancer-mortality-jama-2011/"},{"id":"paper-uspstf-lung-cancer-screening-jama-2021","kind":"paper","name":"Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement","route":"/key-papers/paper-uspstf-lung-cancer-screening-jama-2021/"}],"idea":[{"id":"idea-lung-screening-eligibility-by-risk-not-pack-years","kind":"idea","name":"Decide who is screened for lung cancer by individual risk, not by pack-years","route":"/ideas/idea-lung-screening-eligibility-by-risk-not-pack-years/"},{"id":"idea-prev-lung-screening-risk-model-eligibility","kind":"idea","name":"Lung screening eligibility by risk score, not pack-years, including high-risk never-smokers","route":"/ideas/idea-prev-lung-screening-risk-model-eligibility/"}],"roadmap":[{"id":"lung-cancer-evidence-roadmap","kind":"roadmap","name":"Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch","route":"/roadmaps/lung-cancer-evidence-roadmap/"}],"cancer":[{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"technology":[{"id":"radiology-ai-screening","kind":"technology","name":"AI in radiology","route":"/technologies/radiology-ai-screening/"},{"id":"ct","kind":"technology","name":"CT (computed tomography)","route":"/technologies/ct/"},{"id":"low-dose-ct-screening","kind":"technology","name":"Low-dose CT lung screening","route":"/technologies/low-dose-ct-screening/"}],"term":[{"id":"ppv","kind":"term","name":"Positive predictive value (PPV)","route":"/terms/ppv/"},{"id":"stage-shift","kind":"term","name":"Stage shift","route":"/terms/stage-shift/"}],"trial":[{"id":"nlst-nelson","kind":"trial","name":"NLST & NELSON (low-dose CT screening)","route":"/trials/nlst-nelson/"}],"bottleneck":[{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}],"person":[{"id":"harry-de-koning","kind":"person","name":"Harry J. de Koning","route":"/people/harry-de-koning/"}]}}