Final screening round of the NELSON lung cancer screening trial: the effect of a 2.5-year screening interval

Yousaf-Khan, Uraujh; Aalst, Carlijn van der; Jong, Pim A. de; Heuvelmans, Marjolein A; Scholten, Ernst Th.; Lammers, Jan-Willem; Ooijen, Peter M. A. van; Nackaerts, Kristiaan; Weenink, Carla; Groen, Harry J.M.; Vliegenthart, Rozemarijn; Haaf, Kevin ten; Oudkerk, Matthijs; Koning, Harry J. de

doi:10.1136/thoraxjnl-2016-208655

Cited by 238 publications

(169 citation statements)

References 22 publications

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“…In the MILD, the biennial screening showed the same efficacy as annual screening, according to the comparable stage distributions between two screening arms (82). Recent NELSON data showed that an interval of 2.5 years led to more interval cancers and significantly higher proportion of advanced stage lung cancers (stage IIIB-IV) (83). In the NELSON, it was also found that, when the baseline screening test result turned out negative, the probability of a lung cancer diagnosis in the next 2 years after the prevalence screen was only 0.4%.…”

Section: When To Conduct Next Screeningmentioning

confidence: 95%

Screening for early stage lung cancer and its correlation with lung nodule detection

Qian¹,

Yang²,

Chen³

et al. 2018

J. Thorac. Dis.

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Currently, the most effective way of reducing lung cancer mortality is early diagnosis of lung cancer. The National Lung Screening Trial has proved the efficacy of lung cancer screening using lowdose computed tomography to reduce lung cancer mortality. However, many questions remain surrounding lung cancer screening implementation, among which include how to select the optimal risk population, the personalized screening interval based different levels of risk, methods to improve diagnostic discrimination between malignant and benign disease in detected lung nodules, and the roles of biomolecular markers in stratifying risk and in guiding the management of indeterminate nodules. This review concentrates on the latest developments of lung cancer screening and provides an overview of the main unanswered questions on lung nodule detection. J Thorac Dis 2018;10(Suppl 7):S846-S859 jtd.amegroups.com reviews the latest progress in lung cancer screening and the main unanswered questions on lung nodule detection, to discuss optimal strategies for implementation of lung cancer detection. How to conduct screening Screening by thoracic imageryThe NLST enrolled high-risk asymptomatic individuals: age, 55-74 years; current or former smokers who quit within 15 years with at least 30 pack-years of smoking history. From August 2002 through April 2004 individuals were randomly assigned to annual LDCT screening scans versus CXR for three consecutive years. After a median follow-up of 6.5 years, the study showed that screening lead to a significant reduction of 20% and 6.7% in lung cancer and overall mortality, respectively. LDCT showed better performance for the detection of early-stage lung cancer, with 57% of screening-detected lung cancer cases of stages I or II, compared to only 39% in the CXR arm (9). This has led to the American Cancer Society's guidelines now recommending LDCT screening in high risk individuals aged 55 to 80 years who have a 30-year pack smoking history and currently smoke or have quit within the past 15 years (12).The impact of LDCT screening versus usual care or CXR have been also compared by several large-scale European randomized trials: Dutch-Belgian Randomized Lung Cancer Screening (NELSON) trial (13) (19). So far, the three published trials have reported conflicting results against NLST. The DLCST showed higher rate of all-cause mortality in the CT screening arm compared with usual care [relative risk (RR) 1.03; 95% CI: 0.66-1.60] (20,21). In the DANTE trial, CT screening demonstrated no significant effect on reduce of mortality (RR 0.99; 95% CI: 0.69-1.43) (15). The MILD trial found no effect of biennial screening compared with usual care and a negative effect of annual screening with more detected cancers but also higher all-cause mortality (RR 1.99; 95% CI: 0.80-4.96) (16). It has raised questions about whether the much smaller patient sample size and the inclusion of patients at lower risk (less exposure to tobacco) for lung cancer in these trials diluted any potential benefits of LDCT s...

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Section: When To Conduct Next Screeningmentioning

confidence: 95%

Screening for early stage lung cancer and its correlation with lung nodule detection

Qian¹,

Yang²,

Chen³

et al. 2018

J. Thorac. Dis.

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“…A NEL-SON vizsgálat utolsó szűrési körének eredményeit 2016 nyarán közölték [20], további eredmények közlése folyamatban van. Hazánkban két vizsgálat ismert, amely az alacsony dózisú CT-vel történő tüdőrákszűrés hatásossá-gának megítélésével foglalkozik.…”

Section: Hatásosságunclassified

Az alacsony dózisú CT-vel végzett tüdőrákszűrés magyarországi egészség-gazdaságtani elemzésének koncepcionális terve

Vokó¹,

Barra²,

Molnár³

et al. 2017

Orvosi Hetilap

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Bevezetés: A tüdőrák gyors lefolyású, jellemzően végzetes kimenetelű betegség, amely világszerte jelentős terhet ró a társadalomra. A magyar egészségügy forrásoldalának szűkösségét ismerve egészségpolitikai szempontból alapvető jelentőségű a szűrés bevezetésével kapcsolatban a költség-hatékonyság kérdése. Célkitűzés: A tanulmány célja a magyarországi alacsony dózisú komputertomográfiával végzett tüdőrákszűrés költség-hatékonysági modell koncepciójának kialakítása, illetve az elemzés megvalósításához szükséges lépések számbavétele. Módszer: Célzott irodalomkutatást végeztünk a szűrés hatásosságára és költség-hatékonyságára vonatkozó bizonyíté-kok azonosítására, majd a találatokat a magyarországi viszonyokra való általánosíthatóság alapján értékeltük. Emellett áttekintettük a hazai tudományos bizonyítékokat és rekonstruáltuk a szűrés során előforduló betegutakat. Eredmények: Mindezek alapján Magyarországon az alacsony dózisú komputertomográfiával végzett tüdőrákszűrés teljes körű gazdasági elemzéséhez egy komplex, több almodellből álló modellstruktúrát javaslunk, amely alkalmas a kockázatnak kitett populáció élethosszig tartó követésére. Következtetések: A költség-hatékonysági modell adatokat szolgáltathat további olyan elemzésekhez, amelyek segítik az alacsony dózisú komputertomográfiával végzett tüdőrákszűrés népegészségügyi programként történő bevezetésére vonatkozó szakmai döntések meghozatalát. Orv Hetil. 2017; 158(25): 963-975. Kulcsszavak: alacsony dózisú CT, tüdőrákszűrés, egészség-gazdaságtani modell, költség-hatékonyság Model concept of the health economic evaluation of low-dose CT lung cancer screening in HungaryIntroduction: Lung cancer is a rapidly progressing, often life-threatening disease that constitutes a huge societal burden. Because of the scarce resources of the Hungarian health care system, the cost-effectiveness of introducing lowdose computed tomography screening is a relevant health policy matter. Aim: The aim of this study is to design a model concept for assessing the cost-effectiveness of low-dose computed tomography lung cancer screening in Hungary, and to define the required steps for performing the analysis. Method: A targeted literature review was conducted to identify and synthesize the evidence on efficacy and effectiveness of screening, and results were evaluated based on adaptability to Hungarian settings. We also summarized the available Hungarian scientific evidence and reconstructed the potential patient pathways. Results: In accordance with these findings, we recommend to perform the full health-economic evaluation of lowdose computed tomography lung cancer screening using a complex model structure that consists of several sub-models and is capable to follow the population at risk on life-time horizon.

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“…This is all the more relevant because recruitment into a lung cancer screening programme does not appear to increase the likelihood of smoking cessation [23][24][25] and reduce it [19]. Offering smoking cessation, which is one of the most cost-effective of all heath interventions, within a screening programme has been shown to improve the cost-effectiveness of the screening-by 20-45% [26,27].…”

Section: Downsides Of Ldct Screeningmentioning

confidence: 99%

“…After medians of 34 and 58 months of follow-up, respectively, not even a trend towards reduced mortality was found: (DANTE, relative risk [RR], 0.97; 95% CI, 0.71-1.32; P = 0.84) (DLCST, RR, 1.15; 95% CI, 0.83-1.61; P = 0.430) [16,17]. The NELSON study is the largest European study so far performed, with 15,822 participants, and has employed a volumetry-based LDCT screening protocol with longer intervals between screening rounds [18,19]. These investigators greatly reduced their reported false-positive rate when compared with the figure reported in NLST (23.3% in NLST vs. 3.6% in NELSON) by changing the definition of "false positive" to include only those nodules that had a baseline appearance or interval growth that supported malignancy.…”

Section: European Studiesmentioning

confidence: 99%

Low-Dose Computed Tomography Screening for Lung Cancer

Rogers¹

2017

A Global Scientific Vision - Prevention, Diagnosis, and Treatment of Lung Cancer

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In the landmark American National Lung Cancer Screening Trial (NLST), low-dose CT (LDCT) screening produced a relative mortality reduction of 20%. These results have not been replicated in any of the European studies, although these are of limited statistical power. Besides doubt about the general applicability of the NLST findings, if LDCT screening is to be successfully implemented, a number of developments are still required, including better characterisation of entry criteria and refinement of screening and nodule management protocols. The high incidence of false-positive findings increases costs and morbidity. Even when histologically malignant tumours are identified, frequently these would not have manifested as disease, i.e. they are "overdiagnosed". These patients are liable to receive unnecessary treatment. LDCT screening is relatively expensive in comparison with other cancer screening modalities. Whilst cost-effectiveness can be improved by integration with smoking cessation programmes, how this would be done in practice remains unclear. Furthermore, individuals at high-risk of lung cancer are virtually by definition risk prone, raising concerns about how attractive participation in a screening programme would be, especially given the very small reported absolute risk reduction in the NLST.

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Final screening round of the NELSON lung cancer screening trial: the effect of a 2.5-year screening interval

Abstract: ISRCTN63545820.

Cited by 238 publications

References 22 publications

Screening for early stage lung cancer and its correlation with lung nodule detection

Screening for early stage lung cancer and its correlation with lung nodule detection

Az alacsony dózisú CT-vel végzett tüdőrákszűrés magyarországi egészség-gazdaságtani elemzésének koncepcionális terve

Low-Dose Computed Tomography Screening for Lung Cancer

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