In October 2010, the National Cancer Institute (NCI) announced that patients who were randomly assigned to screening with low-dose computed tomography (CT) had fewer deaths from lung cancer than did patients randomly assigned to screening with chest radiography. The first report of the NCI-sponsored National Lung Screening Trial (NLST) in a peer-reviewed medical journal appears in this issue of the Journal.
Eligible participants were between 55 and 74 years of age and had a history of heavy smoking. They were screened once a year for 3 years and were then followed for 3.5 additional years with no screening. At each round of screening, results suggestive of lung cancer were nearly three times as common in participants assigned to low-dose CT as in those assigned to radiography, but only 2 to 7% of these suspicious results proved to be lung cancer. Invasive diagnostic procedures were few, suggesting that diagnostic CT and comparison with prior images usually sufficed to rule out lung cancer in participants with suspicious screening findings. Diagnoses of lung cancer after the screening period had ended were more common among participants who had been assigned to screening with chest radiography than among those who had been assigned to screening with low-dose CT, suggesting that radiography missed cancers during the screening period. Cancers discovered after a positive low-dose CT screening test were more likely to be early stage and less likely to be late stage than were those discovered after chest radiography. There were 247 deaths from lung cancer per 100,000 person-years of follow-up after screening with low-dose CT and 309 per 100,000 person-years after screening with chest radiography........
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