TY - JOUR
T1 - Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial
AU - de Koning, Harry J
AU - van der Aalst, Carlijn M
AU - de Jong, Pim A
AU - Scholten, Ernst T
AU - Nackaerts, Kristiaan
AU - Heuvelmans, Marjolein A
AU - Lammers, Jan-Willem J
AU - Weenink, Carla
AU - Yousaf-Khan, Uraujh
AU - Horeweg, Nanda
AU - van 't Westeinde, Susan
AU - Prokop, Mathias
AU - Mali, Willem P
AU - Mohamed Hoesein, Firdaus A A
AU - van Ooijen, Peter M A
AU - Aerts, Joachim G J V
AU - den Bakker, Michael A
AU - Thunnissen, Erik
AU - Verschakelen, Johny
AU - Vliegenthart, Rozemarijn
AU - Walter, Joan E
AU - Ten Haaf, Kevin
AU - Groen, Harry J M
AU - Oudkerk, Matthijs
N1 - Funding Information:
Supported by the Netherlands Organization of Health Research and Development, the Dutch Cancer Society (KWF Kankerbestrijding), the Health Insurance Innovation Foundation (Innovatiefonds Zorgverzekeraars), G.Ph. Verhagen Sticht-ing, the Rotterdam Oncologic Thoracic Study Group, the Erasmus Trust Fund, Stichting tegen Kanker, Vlaamse Liga tegen Kanker, and Lokaal Gezondheids Overleg (LOGO) Leuven. Siemens Germany provided four workstations and software for volume measurements.
Funding Information:
Supported by the Netherlands Organization of Health Research and Development, the Dutch Cancer Society (KWF Kankerbestrijding), the Health Insurance Innovation Foundation (Innovatiefonds Zorgverzekeraars), G.Ph. Verhagen Stichting, the Rotterdam Oncologic Thoracic Study Group, the Erasmus Trust Fund, Stichting tegen Kanker, Vlaamse Liga tegen Kanker, and Lokaal Gezondheids Overleg (LOGO) Leuven. Siemens Germany provided four workstations and software for volume measurements.
Publisher Copyright:
Copyright © 2020 Massachusetts Medical Society.
PY - 2020/2/6
Y1 - 2020/2/6
N2 - BACKGROUND: There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and current smokers.METHODS: A total of 13,195 men (primary analysis) and 2594 women (subgroup analyses) between the ages of 50 and 74 were randomly assigned to undergo CT screening at T0 (baseline), year 1, year 3, and year 5.5 or no screening. We obtained data on cancer diagnosis and the date and cause of death through linkages with national registries in the Netherlands and Belgium, and a review committee confirmed lung cancer as the cause of death when possible. A minimum follow-up of 10 years until December 31, 2015, was completed for all participants.RESULTS: Among men, the average adherence to CT screening was 90.0%. On average, 9.2% of the screened participants underwent at least one additional CT scan (initially indeterminate). The overall referral rate for suspicious nodules was 2.1%. At 10 years of follow-up, the incidence of lung cancer was 5.58 cases per 1000 person-years in the screening group and 4.91 cases per 1000 person-years in the control group; lung-cancer mortality was 2.50 deaths per 1000 person-years and 3.30 deaths per 1000 person-years, respectively. The cumulative rate ratio for death from lung cancer at 10 years was 0.76 (95% confidence interval [CI], 0.61 to 0.94; P = 0.01) in the screening group as compared with the control group, similar to the values at years 8 and 9. Among women, the rate ratio was 0.67 (95% CI, 0.38 to 1.14) at 10 years of follow-up, with values of 0.41 to 0.52 in years 7 through 9.CONCLUSIONS: In this trial involving high-risk persons, lung-cancer mortality was significantly lower among those who underwent volume CT screening than among those who underwent no screening. There were low rates of follow-up procedures for results suggestive of lung cancer. (Funded by the Netherlands Organization of Health Research and Development and others; NELSON Netherlands Trial Register number, NL580.).
AB - BACKGROUND: There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and current smokers.METHODS: A total of 13,195 men (primary analysis) and 2594 women (subgroup analyses) between the ages of 50 and 74 were randomly assigned to undergo CT screening at T0 (baseline), year 1, year 3, and year 5.5 or no screening. We obtained data on cancer diagnosis and the date and cause of death through linkages with national registries in the Netherlands and Belgium, and a review committee confirmed lung cancer as the cause of death when possible. A minimum follow-up of 10 years until December 31, 2015, was completed for all participants.RESULTS: Among men, the average adherence to CT screening was 90.0%. On average, 9.2% of the screened participants underwent at least one additional CT scan (initially indeterminate). The overall referral rate for suspicious nodules was 2.1%. At 10 years of follow-up, the incidence of lung cancer was 5.58 cases per 1000 person-years in the screening group and 4.91 cases per 1000 person-years in the control group; lung-cancer mortality was 2.50 deaths per 1000 person-years and 3.30 deaths per 1000 person-years, respectively. The cumulative rate ratio for death from lung cancer at 10 years was 0.76 (95% confidence interval [CI], 0.61 to 0.94; P = 0.01) in the screening group as compared with the control group, similar to the values at years 8 and 9. Among women, the rate ratio was 0.67 (95% CI, 0.38 to 1.14) at 10 years of follow-up, with values of 0.41 to 0.52 in years 7 through 9.CONCLUSIONS: In this trial involving high-risk persons, lung-cancer mortality was significantly lower among those who underwent volume CT screening than among those who underwent no screening. There were low rates of follow-up procedures for results suggestive of lung cancer. (Funded by the Netherlands Organization of Health Research and Development and others; NELSON Netherlands Trial Register number, NL580.).
KW - lung cancer
UR - http://www.scopus.com/inward/record.url?scp=85078946747&partnerID=8YFLogxK
U2 - 10.1056/NEJMoa1911793
DO - 10.1056/NEJMoa1911793
M3 - Article
C2 - 31995683
SN - 0028-4793
VL - 382
SP - 503
EP - 513
JO - The New England journal of medicine
JF - The New England journal of medicine
IS - 6
ER -