The National Lung Screening Trial: Overview and Study Design

Abstract

The National Lung Screening Trial (NLST) is a randomized multicenter study comparing low-dose helical computed tomography (CT) with chest radiography in the screening of older current and former heavy smokers for early detection of lung cancer, which is the leading cause of cancer-related death in the United States. Five-year survival rates approach 70% with surgical resection of stage IA disease; however, more than 75% of individuals have incurable locally advanced or metastatic disease, the latter having a 5-year survival of less than 5%. It is plausible that treatment should be more effective and the likelihood of death decreased if asymptomatic lung cancer is detected through screening early enough in its preclinical phase. For these reasons, there is intense interest and intuitive appeal in lung cancer screening with low-dose CT. The use of survival as the determinant of screening effectiveness is, however, confounded by the well-described biases of lead time, length, and overdiagnosis. Despite previous attempts, no test has been shown to reduce lung cancer mortality, an endpoint that circumvents screening biases and provides a definitive measure of benefit when assessed in a randomized controlled trial that enables comparison of mortality rates between screened individuals and a control group that does not undergo the screening intervention of interest. The NLST is such a trial. The rationale for and design of the NLST are presented.

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Affiliated Institutions

• Ann Arbor Center for Independent Living US
• George Washington University US
• Mayo Clinic US
• University of Utah US
• University of California, Los Angeles US
• University of Alabama at Birmingham US
• Marshfield Clinic US
• Ford Motor Company (United States) US
• Emory University US
• Brown University US
• The University of Texas MD Anderson Cancer Center US
• University of Pennsylvania US
• University of Minnesota System US
• Wake Forest University US
• Harvard University Press US
• National Institutes of Health US
• Northwestern University US
• Westat (United States) US
• University of Iowa US
• Philadelphia University US
• University of South Florida US
• American College of Radiology US
• University of California, San Diego US
• University of Colorado Denver US
• University of Michigan US
• Vanderbilt University US
• Jewish Hospital US
• Johns Hopkins University US
• Dartmouth College US
• Washington University in St. Louis US
• Medical University of South Carolina US
• WinnMed US

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