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Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial
Open accessAbstract
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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“demonstrating that low-dose computed tomography substantially reduces deaths from lung cancer.”
From Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. (2024) · cites this paper as [40]
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Self-citation
Metadata
- 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
- 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
- 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
- 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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