Thursday, January 6, 2011

CT scan for lung cancer screening

The National Lung Cancer Screening trial (NSLT) ..comparing two ways of detecting lung cancer- low dose helical CT Vs regular chest xray was stopped in Nov 2010 , after the results showed a dramatic reduction in mortality!


The trial began in 2002 and involved more than 53,000 current and former heavy smokers(quit within last 15 years) 55 to 74 years of age. Individuals were randomized to undergo screening annually for 3 years with either CT or chest x-rays, and were then followed for another 5 years.
The results, which were reviewed by the trial's Data and Safety Monitoring Board on October 20, show a statistically significant difference in lung cancer mortality in the 2 groups, which led to the trial being halted. There were 354 lung cancer deaths among those who underwent CT screening and 442 among those who underwent chest x-ray.This is a 20% reduction in mortality in patients who underwent screening with CT scan. This is an impressive finding....but the study has not been published yet. Questions do remain......who is at high risk? and who needs CT scan? There will also be a problem with false positivies, as with any other screening test. So will be interesting to see the cut off criteria for doing a screening CT scan.


Thus far, there has been no recommendation for lung cancer screening from any authority, but these new data might be a turning point.  Keeping in mind that Lung cancer is the leading cause of cancer mortality in US  and worldwide....screening will help reduce the associated mortality. But the most important intervention that will reduce mortality will be staying away from Tobacco!!

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