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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.
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.
The 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.
NELSON confirmed NLST against a no-screening control and gave European programmes a workable protocol.
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.
The document that defines who is offered a scan in the United States, and therefore the document any argument about the screening eligibility gap has to engage with. Eligibility is still defined by pack-years and years since quitting rather than by an individual risk estimate.
A negative screening trial that saved a generation from a useless test, and the reason low-dose computed tomography had to be proved separately rather than assumed to work because it saw more.
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