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Evevident
Original paper
2011NEJMPreventive/Primary Care

NLST

Reduced lung-cancer mortality with low-dose computed tomographic screening

RCTCancer screening

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Overview

Low-dose CT screening reduced lung-cancer mortality in high-risk smokers.

Clinical takeaway

NLST is the evidence anchor for low-dose CT lung cancer screening in appropriately selected current and former smokers.

Key result

Lung-cancer mortality was reduced by 20% with low-dose CT versus chest radiography.

Practice impact

Low-dose CT became guideline-recommended lung cancer screening for high-risk smoking histories.

Evidence

Study design

Randomized controlled screening trial.

Enrollment

53,454

Follow-up

Median 6.5 years.

Geography

United States

Clinical question

Does annual low-dose CT reduce lung-cancer mortality compared with chest radiography in high-risk smokers?

Population

  • Adults 55-74 years old with at least 30 pack-years of smoking who were current smokers or had quit within 15 years.

Intervention

Three annual low-dose CT screens.

Comparator

Three annual single-view chest radiographs.

Primary outcome

Lung-cancer mortality.

Low-dose CT screening reduced lung-cancer mortality compared with chest radiography among high-risk smokers.

Relative reduction / 20 / CI 95% CI 6.8-26.7% / p=0.004

Key results

  • Lung-cancer mortality was reduced by 20.0% with low-dose CT.
  • All-cause mortality was reduced by 6.7%.
  • False-positive screening results were common.

Harms

  • False positives and downstream imaging/procedures were common.
  • Radiation exposure and overdiagnosis are important screening harms.

Clinical Use

When to cite

  • When counseling eligible smokers about low-dose CT lung cancer screening.

Practice impact

  • Provided the mortality evidence behind modern USPSTF-style lung cancer screening programs.

Applicability

  • High-risk current or former smokers meeting age and pack-year criteria and fit enough for curative treatment.

Limitations

  • Comparator was chest radiography, not no screening.
  • Trial eligibility differs from current guideline age and pack-year thresholds.
  • Screening requires systems for nodule follow-up and smoking cessation support.

Common misinterpretations

  • Do not offer screening to patients who would not pursue or tolerate lung cancer treatment.

Related evidence

Women's Health Initiative - Context

Citation

National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409. doi:10.1056/NEJMoa1102873

The rate of death from lung cancer was 20.0% lower with low-dose CT screening than with chest radiography.