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Three annual low-dose CT scans reduced lung cancer deaths by a fifth compared with chest X-rays in current and former heavy smokers.
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.
The 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.
NLST is the evidence base for US Preventive Services Task Force lung screening recommendations and for national programmes that followed.
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.
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.
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 clearest published demonstration that a screening eligibility rule can be accurate on average and systematically wrong for a group. It is the empirical core of the argument for replacing pack-year thresholds with individual risk models.
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.
Shares Take lung screening scanners to supermarket car parks in the poorest areas, Evaluation of USPSTF Lung Cancer Screening Guidelines Among African American Adult Smokers, Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement, 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.
Shares Take lung screening scanners to supermarket car parks in the poorest areas, Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement, 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, The hardest cancers are found late.
Shares NLST & NELSON (low-dose CT screening), Stage shift, Low-dose CT lung screening, CT (computed tomography).
Shares Screening by chest radiograph and lung cancer mortality: the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized trial, Decide who is screened for lung cancer by individual risk, not by pack-years, Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement, Positive predictive value (PPV).
Shares Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement, Low-dose CT lung screening, 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, Prevention we already have is not deployed.
Shares Take lung screening scanners to supermarket car parks in the poorest areas, Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement, Small-cell lung cancer, Lung cancer (all types).
Shares Positive predictive value (PPV), Stage shift, Overdiagnosis and false alarms, Prevention we already have is not deployed.
Shares Stage shift, Low-dose CT lung screening, Overdiagnosis and false alarms, The hardest cancers are found late.