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Lessons on managing pulmonary nodules from NELSON: we have come a long way
  1. Carolyn Horst1,
  2. Arjun Nair2,
  3. Sam M Janes3
  1. 1 Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom
  2. 2 Department of Radiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
  3. 3 Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
  1. Correspondence to Professor Sam M Janes, Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom; s.janes{at}ucl.ac.uk

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The results of the Dutch-Belgian low-dose CT (LDCT) screening trial (NELSON) have been eagerly awaited since the US National Lung Screening Trial (NLST), published in 2011, demonstrated annual LDCT screening of the chest led to a 20% decrease in lung cancer mortality compared with chest X-ray screening.1 While the US Preventative Service Task Force approved lung cancer screening in 2014,2 Europe and the rest of the globe have been paralysed by fear of implementation costs and the feasibility of introducing national LDCT screening programmes. The consensus from healthcare payers outside of the USA has been that we should wait for the results of the NELSON trial which, while smaller in size, would give us the confidence of a second randomised controlled trial and proof of effect in a population outside of the US healthcare system. Indeed, a recent Health Technology Assessment of LDCT screening in the UK specifically named the NELSON trial as an important source of future information and explicitly stated the results were required in order to make a decision about its efficacy and cost-effectiveness.3 It was on this background of hope and perhaps, dare we say it, healthcare payer fear that the NELSON trial preliminary results were released at the World Conference on Lung Cancer in Toronto in October.

Despite NELSON being smaller in size than NLST and having a preponderance of male participants, the results were clear: LDCT screening compared with no screening leads to a statistically significant lung cancer mortality reduction of 26% for men and numbers hint that the benefit could be even greater in women (between 40% and 60%). With this new data the UK, and indeed the world outside of the USA, now needs to cast aside concerns over efficacy, as well as procrastination over implementation, and concentrate more …

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