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Risk stratification based on screening history: the NELSON lung cancer screening study
  1. Uraujh Yousaf-Khan1,
  2. Carlijn van der Aalst1,
  3. Pim A de Jong2,
  4. Marjolein Heuvelmans3,
  5. Ernst Scholten2,4,
  6. Joan Walter3,
  7. Kristiaan Nackaerts5,
  8. Harry Groen6,
  9. Rozemarijn Vliegenthart3,
  10. Kevin ten Haaf1,
  11. Matthijs Oudkerk3,
  12. Harry de Koning1
  1. 1 Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2 Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3 University of Groningen, University Medical Center Groningen, Center for Medical Imaging—North East Netherlands, Groningen, The Netherlands
  4. 4 Department of Radiology, Kennemer Gasthuis, Haarlem, The Netherlands
  5. 5 Department of Pulmonary Medicine, KU leuven, University Hospital Leuven, Leuven, Belgium
  6. 6 Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen,  Groningen, The Netherlands
  1. Correspondence to Uraujh Yousaf-Khan, Erasmus Medical Center, University Medical Center Rotterdam, Department of Public Health, Room Na 22-09, PO Box 2040, Rotterdam 3000 CA, The Netherlands; a.yousaf{at}


Background Debate about the optimal lung cancer screening strategy is ongoing. In this study, previous screening history of the Dutch-Belgian Lung Cancer Screening trial (NELSON) is investigated on if it predicts the screening outcome (test result and lung cancer risk) of the final screening round.

Methods 15 792 participants were randomised (1:1) of which 7900 randomised into a screening group. CT screening took place at baseline, and after 1, 2 and 2.5 years. Initially, three screening outcomes were possible: negative, indeterminate or positive scan result. Probability for screening outcome in the fourth round was calculated for subgroups of participants.

Results Based on results of the first three rounds, three subgroups were identified: (1) those with exclusively negative results (n=3856; 73.0%); (2) those with ≥1 indeterminate result, but never a positive result (n=1342; 25.5%); and (3) with ≥1 positive result (n=81; 1.5%). Group 1 had the highest probability for having a negative scan result in round 4 (97.2% vs 94.8% and 90.1%, respectively, p<0.001), and the lowest risk for detecting lung cancer in round 4 (0.6% vs 1.6%, p=0.001). ‘Smoked pack-years’ and ‘screening history’ significantly predicted the fourth round test result. The third round results implied that the risk for detecting lung cancer (after an interval of 2.5 years) was 0.6% for those with negative results compared with 3.7% of those with indeterminate results.

Conclusions Previous CT lung cancer screening results provides an opportunity for further risk stratifications of those who undergo lung cancer screening.

Trial registration number Results, ISRCTN63545820.

  • Lung Cancer
  • Smoking cessation
  • Tobacco and the lung
  • Clinical Epidemiology

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  • Contributors UY-K, CvdA, MO and HdK: involvement in the conception, hypothesis delineation and design of the study. UY-K, CvdA, PAdJ, ES, JW, RV, MO and HdK: acquisition of the data or the analysis and interpretation of such information. UY-K, CvdA, PAdJ, MH, ES, JW, KN, HG, RV, KtH, MO and HdK: writing the article or substantial involvement in its revision prior to submission.

  • Funding The NELSON trial is presently supported by ‘The Netherlands Organisation for Health Research and Development’ (ZonMw).

  • Competing interests Siemens Germany provided four digital workstations and LungCARE for the performance of 3D measurements of the nodules. Roche diagnostics provided a grant for the performance of proteomics research. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

  • Patient consent Obtained.

  • Ethics approval The NELSON trial was approved by the Dutch Minister of Health and the ethical board at each participating centre. The original NELSON study protocol consisted of three screening rounds. An additional written informed consent form was obtained from all participants who were willing to participate in the fourth screening round.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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