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Lung cancer screening: enhancing risk stratification and minimising harms by incorporating information from screening results
  1. Emma Louise O'Dowd1,
  2. Kevin ten Haaf2
  1. 1 Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
  2. 2 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Dr Emma Louise O'Dowd, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK; emma.o'dowd{at}

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Two large randomised controlled trials of screening for lung cancer with low-dose CT (LDCT)—the National Lung Screening Trial (NLST) and the Dutch-Belgian lung cancer screening trial (Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) trial)—have both shown substantial lung cancer mortality reduction in the LDCT arm.1

Although there is now strong evidence that screening for lung cancer with LDCT reduces lung cancer mortality, concerns have been raised about the potential costs and harms of implementing annual lung cancer screening programmes. Annual screening with LDCT has been recommended in the USA, based on the evidence provided by the NLST design and modelling extrapolations.2 3 However, uptake of screening has been poor, with the latest data showing only 3.9% of those eligible have actually been screened.4 A cost-effectiveness analysis for Ontario, Canada, showed that annual screening scenarios were more cost-effective than biennial screening,5 but there is ongoing debate about whether all of those eligible for lung cancer screening actually require an annual LDCT.

NELSON was the only trial to compare the effects of different screening intervals between rounds. While the proportion of advanced stage cancers increased somewhat, a 2-year interval still had a good performance compared with a 1-year interval. However, there was an increase in interval cancers and a higher proportion of more advanced stage cancers for a 2.5-year interval compared with a 2-year interval suggesting that this may be too long.6

Risk prediction models have been suggested to select eligible participants at high risk of lung cancer and have been shown to be superior to selection using age and smoking status alone.7 8 Incorporating information from LDCT results may allow them to aid in the personalisation of the screening regimen. In NELSON, participants with negative LDCT results were less likely to have lung cancer detected at a …

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  • Contributors EO'D and KtH co-wrote this editorial.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests KtH is a researcher affiliated with the NELSON trial and the Cancer Intervention and Surveillance Modelling Network. KtH was involved in a Health Technology Assessment study for CT Lung Cancer Screening in Canada (Dr Paszat, Cancer Care Ontario) and received a grant from the University of Zurich to assess the cost-effectiveness of CT lung cancer screening in Switzerland.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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