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Why should we want to screen?
Survival (years)
Goldstraw et al. J Thorac Oncol 2007
Why should we want to screen?
Localised
Stage shift !
Regional spread
Distant spread
When diagnosis is
based on symptoms
When diagnosis is
based on screening
National lung screening trial (NLST)
Inclusion criteria
- Age 55-74 years
- Smoking history ≥30PY, active or stopped less than
15 years ago
Exclusion criteria
-
History of lung cancer
Other prior cancer in past 5 years
Chest CT less than 18 months ago
Unexplained weight loss (>15lb in past year)
Metallic implants or devices in chest or back
Home oxygen supplementation
Pneumonia treated with antibiotics in past 12 weeks
Aberle et al. N Engl J Med 2011
National lung screening trial (NLST)
- 53’454 subjects randomised to one of two
groups:
- Low dose CT
- Chest X-ray
- 3 screening rounds at annual intervals
- Non-calcified nodules ≥4mm in CT or any
size in X-ray were referred for diagnostic
work-up
- Primary outcome: lung cancer related
mortality
Aberle et al. N Engl J Med 2011
National lung screening trial (NLST)
Aberle et al. N Engl J Med 2011
National lung screening trial (NLST)
Aberle et al. N Engl J Med 2011
National lung screening trial (NLST)
Kovalchik et al. N Engl J Med 2013
National lung screening trial (NLST)
Kovalchik et al. N Engl J Med 2013
Lung cancer screening trials
Boiselle, JAMA 2013
Screening recommendations
Boiselle, JAMA 2013
Open issues
- Is one positive trial enough evidence?
- Was there overdiagnosis in the NSLT?
- Will other populations at risk of lung cancer benefit
from CT screening?
- Screening of a large, at-risk population possible?
- How many screening rounds?
- Cost effectiveness?
- «side effects» of screening (i.e.radiation exposure)
Conclusions
 Lung cancer is a lethal disease associated with substantial
medical and economic burden.
 NLST: lung cancer screening may reduce mortality considerably.
 Possible advantage of LDCT screening has to be balanced
against the potential of inducing harm.
 Many issues are not yet resolved: i.e. overdiagnosis, number of
screening rounds, study population, cost-efficacy.
 Further evidence and information is needed, before lung cancer
screening can be recommended in Switzerland.