{"entity":{"id":"paper-nlst-nejm-2011","kind":"paper","name":"NLST: yearly low-dose CT scans cut lung cancer deaths in heavy smokers","aka":[],"tldr":"Three annual low-dose CT scans reduced lung cancer deaths by a fifth compared with chest X-rays in current and former heavy smokers.","summary":"The National Lung Screening Trial randomised 53,454 current or former smokers aged 55-74 with at least 30 pack-years to three annual screens with low-dose helical CT or chest radiography at 33 US centres.\n\nThe primary endpoint was lung cancer mortality. After a median 6.5 years of follow-up there were 247 lung cancer deaths per 100,000 person-years in the CT arm and 309 in the radiography arm, a 20% relative reduction; all-cause mortality also fell by 6.7%. The trial was stopped early for benefit.\n\nNLST is the evidence base for US Preventive Services Task Force lung screening recommendations and for national programmes that followed.","asOf":"2026-09-08","links":[{"label":"DOI","url":"https://doi.org/10.1056/NEJMoa1102873"},{"label":"ClinicalTrials.gov NCT00047385","url":"https://clinicaltrials.gov/study/NCT00047385"}],"tags":[],"related":["cdas-nlst-plco","idea-prev-lung-screening-risk-model-eligibility","idea-prev-mobile-lung-screening-deprived-areas","lung-cancer-evidence-roadmap","paper-plco-chest-radiograph-lung-cancer-mortality-jama-2011","paper-uspstf-lung-cancer-screening-jama-2021","idea-lung-screening-eligibility-by-risk-not-pack-years"],"cancers":["nsclc","sclc","lung-cancer"],"sections":["early-detection","prevention"],"technologies":["low-dose-ct-screening","ct"],"targets":[],"drugs":[],"companies":[],"institutions":["nci"],"pathways":[],"terms":["ppv","stage-shift"],"trials":["nlst-nelson"],"people":[],"bottlenecks":["b-early-detection","b-overdiagnosis","b-prevention-adoption"],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2011,"doi":"10.1056/NEJMoa1102873","pmid":"21714641","authors":"Aberle DR, Adams AM, Berg CD, et al. (National Lung Screening Trial Research Team)","paperType":"rct","findings":["Lung cancer mortality reduced by 20.0% (95% CI 6.8-26.7) with low-dose CT versus chest radiography","All-cause mortality reduced by 6.7% (95% CI 1.2-13.6)","24.2% of CT screens were positive, and 96.4% of positive screens were false positives","Roughly 320 people had to be screened to prevent one lung cancer death over the trial period"],"whatItMeans":"For people with a heavy smoking history, an annual low-dose CT scan is one of the few screening tests proven to reduce cancer deaths. Most abnormal scans are not cancer, so screening must be paired with careful nodule management. It does not apply to never-smokers or light smokers.","caveats":["High false-positive rate with the 4 mm nodule threshold used in 2002-2004; modern Lung-RADS criteria reduce this","Comparator was chest X-ray, itself of no proven benefit, so the effect versus no screening may differ","Participants were younger, better educated and more often former smokers than the US smoking population","Uptake of screening among eligible people remains low in most countries"],"changedPractice":true,"participants":53454},"route":"/key-papers/paper-nlst-nejm-2011/","neighbours":{"collection":[{"id":"cdas-nlst-plco","kind":"collection","name":"NCI CDAS: NLST and PLCO screening trial data","route":"/collections/cdas-nlst-plco/"}],"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/"},{"id":"idea-prev-mobile-lung-screening-deprived-areas","kind":"idea","name":"Take lung screening scanners to supermarket car parks in the poorest areas","route":"/ideas/idea-prev-mobile-lung-screening-deprived-areas/"}],"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/"}],"paper":[{"id":"paper-aldrich-uspstf-screening-african-american-smokers-jama-oncol-2019","kind":"paper","name":"Evaluation of USPSTF Lung Cancer Screening Guidelines Among African American Adult Smokers","route":"/key-papers/paper-aldrich-uspstf-screening-african-american-smokers-jama-oncol-2019/"},{"id":"paper-nelson-nejm-2020","kind":"paper","name":"NELSON: volume-based CT screening reduces lung cancer deaths with fewer false alarms","route":"/key-papers/paper-nelson-nejm-2020/"},{"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/"}],"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/"},{"id":"resectable-nsclc","kind":"cancer","name":"Resectable stage I to III non-small-cell lung cancer","route":"/cancers/resectable-nsclc/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"},{"id":"prevention","kind":"section","name":"Prevention & Risk","route":"/fronts/prevention/"}],"technology":[{"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/"}],"institution":[{"id":"nci","kind":"institution","name":"National Cancer Institute (NIH)","route":"/institutions/nci/"}],"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-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","route":"/bottlenecks/b-prevention-adoption/"},{"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":"denise-aberle","kind":"person","name":"Denise R. Aberle","route":"/people/denise-aberle/"},{"id":"harry-de-koning","kind":"person","name":"Harry J. de Koning","route":"/people/harry-de-koning/"}]}}