Journal article

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Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial

Author(s): de Koning HJ, van der Aalst CM, de Jong PA et al

N Engl J Med 2020; 382: 503-513

Thoracic oncology
Epidemiology
General respiratory patient care
Imaging

Digest Author(s): Stylianos Loukides, e-Learning Director / 7 February, 2020

Lung cancer is the leading cause of death from cancer worldwide. A limited number of patients are still alive five years from the initial diagnosis. Most of the patients have advanced diseases at the time of diagnosis. in this randomized trial the authors wanted to determine whether a volume based CT screening is associated with low lung cancer mortality in people who are current or former smokers. 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. Data for diagnosis or/and death obtained from national registries and extensively reviewed by an experienced committee. A minimum 10 years follow up was achieved. Τhe 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; Mortality was 24% lower in the screening group compared to placebo. The mortality rate was further reduced in women with a rate ratio 0.67. The authors finally concluded that lung-cancer mortality was significantly lower among those who underwent volume CT screening than among those who underwent no screening.

Comments

Considering the US screening trial, where more than 50000 people were recruited, three annual CT screenings resulted in 20.0% lower morality from lung cancer than screening with the use of chest radiography. The follow up period was almost seven years. Three arising questions-comments.

  • For how long we have to screen high risk people? Which is the best method?
  • Do we have gender related differences?
  • Is the growth-rate assessment the ideal imaging based approach?

In what we all agree is that the screening approach represents an effective approach for reducing lung cancer related mortality.