Cited by 3,624Lung Cancer Diagnosis and TreatmentGlobal Cancer Incidence and ScreeningOccupational and environmental lung diseases

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Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial

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de Koning, Harry J., van der Aalst, Carlijn M., de Jong, Pim A., Scholten, Ernst T., Nackaerts, Kristiaan, Heuvelmans, Marjolein A., Lammers, Jan-Willem J., Weenink, Carla, Yousaf-Khan, Uraujh, Horeweg, Nanda, van ’t Westeinde, Susan, Prokop, Mathias, Mali, Willem P., Mohamed Hoesein, Firdaus A.A., van Ooijen, Peter M.A., Aerts, Joachim G.J.V., den Bakker, Michael A., Thunnissen, Erik, Verschakelen, Johny, Vliegenthart, Rozemarijn, Walter, Joan E., ten Haaf, Kevin, Groen, Harry J.M., Oudkerk, Matthijs·2020·New England Journal of Medicine

DOI 10.1056/nejmoa1911793

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Abstract

BACKGROUND: There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and current smokers. METHODS: A total of 13,195 men (primary analysis) and 2594 women (subgroup analyses) between the ages of 50 and 74 were randomly assigned to undergo CT screening at T0 (baseline), year 1, year 3, and year 5.5 or no screening. We obtained data on cancer diagnosis and the date and cause of death through linkages with national registries in the Netherlands and Belgium, and a review committee confirmed lung cancer as the cause of death when possible. A minimum follow-up of 10 years until December 31, 2015, was completed for all participants. RESULTS: Among men, the average adherence to CT screening was 90.0%. On average, 9.2% of the screened participants underwent at least one additional CT scan (initially indeterminate). The overall referral rate for suspicious nodules was 2.1%. At 10 years of follow-up, the incidence of lung cancer was 5.58 cases per 1000 person-years in the screening group and 4.91 cases per 1000 person-years in the control group; lung-cancer mortality was 2.50 deaths per 1000 person-years and 3.30 deaths per 1000 person-years, respectively. The cumulative rate ratio for death from lung cancer at 10 years was 0.76 (95% confidence interval [CI], 0.61 to 0.94; P = 0.01) in the screening group as compared with the control group, similar to the values at years 8 and 9. Among women, the rate ratio was 0.67 (95% CI, 0.38 to 1.14) at 10 years of follow-up, with values of 0.41 to 0.52 in years 7 through 9. CONCLUSIONS: In this trial involving high-risk persons, lung-cancer mortality was significantly lower among those who underwent volume CT screening than among those who underwent no screening. There were low rates of follow-up procedures for results suggestive of lung cancer. (Funded by the Netherlands Organization of Health Research and Development and others; NELSON Netherlands Trial Register number, NL580.).

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Authors: de Koning, H. J., van der Aalst, C. M., de Jong, P. A., Scholten, E. T., Nackaerts, K., Heuvelmans, M. A., Lammers, J.-W. J., Weenink, C., Yousaf-Khan, U., Horeweg, N., van ’t Westeinde, S., Prokop, M., Mali, W. P., Mohamed Hoesein, F. A. A., van Ooijen, P. M. A., Aerts, J. G. J. V., den Bakker, M. A., Thunnissen, E., Verschakelen, J., Vliegenthart, R., Walter, J. E., ten Haaf, K., Groen, H. J. M., & Oudkerk, M.
Affiliations: From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC–University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology,...
Erasmus MC (NL)
Leiden University Medical Center (NL)
University Medical Center Groningen (NL)
ORCID: Scholten, Ernst T.
Nackaerts, Kristiaan
Heuvelmans, Marjolein A.
Lammers, Jan-Willem J.
Horeweg, Nanda
Prokop, Mathias
Mali, Willem P.
Aerts, Joachim G.J.V.
Thunnissen, Erik
Verschakelen, Johny
Vliegenthart, Rozemarijn
Walter, Joan E.
Groen, Harry J.M.
Oudkerk, Matthijs
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2020-02-06
Volume: 382
Issue: 6
Pages: 503-513
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa1911793
OpenAlex: W3003415550
Cited by: 3,624
References: 76
Citations by year: 2026: 538 · 2025: 626 · 2024: 568 · 2023: 588 · 2022: 532 · 2021: 492 · 2020: 275
FWCI: 266.35
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: other-oa
www.nejmgroup.org/legal/terms-of-use.htm (vor)
Locations: New England Journal of Medicine (publishedVersion, other-oa)
PubMed (publishedVersion)
Pure Amsterdam UMC (publishedVersion, cc-by)
EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
Leiden Repository (Leiden University) (submittedVersion)
Lirias (submittedVersion, other-oa)
Radboud Repository (Radboud University) (submittedVersion)
EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion, other-oa)
Radboud Repository (Radboud University) (submittedVersion, other-oa)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
Utrecht University Repository (Utrecht University) (submittedVersion)
Funders: LOGO Leuven
The Netherlands Organization of Health Research and Development
Dutch Cancer Society
Health Insurance Innovation Foundation
Siemens Germany
Roche Diagnostics
G.Ph. Verhagen Stichting
Rotterdam Oncologic Study (ROTS) group
Erasmus Trust Fund
Stichting Tegen Kanker
Vlaamse Liga Tegen Kanker
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Occupational and environmental lung diseases
Keywords: lung cancer screening, low-dose CT, lung cancer mortality, smoking, men, women, screening adherence, lung cancer incidence, NELSON trial, cancer mortality reduction, follow-up procedures, cancer registry linkage, Netherlands, vulnerable populations, cost-effectiveness of screening
MeSH terms: Medical Overuse, Aged, Belgium, False Positive Reactions, Female, Humans, Lung Neoplasms, Male, Middle Aged, Netherlands, Registries, Sex Factors, Smoking, Incidence, Cone-Beam Computed Tomography, Early Detection of Cancer

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Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial

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