The national lung screening trial: Overview and study design

Constantine A. Gatsonis, Denise R. Aberle, Christine D. Berg, William C. Black, Timothy R. Church, Richard M. Fagerstrom, Barbara Galen, Ilana F. Gareen, Jonathan Goldin, John K. Gohagan, Bruce Hillman, Carl Jaffe, Barnett S. Kramer, David Lynch, Pamela M. Marcus, Mitchell Schnall, Daniel C. Sullivan, Dorothy Sullivan, Carl J. Zylak, Christopher CagnonDianna Cody, Glenn Fletcher, Michael J. Flynn, Philip F. Judy, Randell Kruger, Frederick J. Larke, Michael McNitt-Gray, Thomas Payne, J. Anthony Seibert, Xizeng Wu, Gerald Abbott, Judith K. Amorosa, Richard G. Barr, Phillip M. Boiselle, Caroline Chiles, Robert Clark, Lynn Coppage, Robert Falk, Elliot K. Fishman, David Gemmel, Jonathan G. Goldin, Eric Goodman, Eric M. Hart, Todd Hazelton, Elizabeth Johnson, Ella Kazerooni, Barbara McComb, Geoffrey McLennan, Reginald F. Munden, James Ravenel, Michael Sullivan, Stephen J. Swensen, Drew A. Torigian, Kay H. Vydareny, John A. Worrell, Peter Balkin, Mona Fouad, Matthew T. Freedman, Kavita Garg, Edward P. Gelmann, David S. Gierada, William Hocking, Subbarao Inampudi, Claudine Isaacs, Paul Kvale, Howard Mann, William Manor, Hrudaya Nath, Douglas Reding, David L. Spizarny, Diane C. Strollo, John Waltz, Mei Hsiu Chen, Fenghai Duan, Grant Izmirilian, Paul Pinsky, Philip C. Prorok, Anthony B. Miller, Martin J. Edelman, William K. Evans, Robert S. Fontana, Mitchell Machtay, Kenneth W. Clark, Kathy L. Clingan, Melissa B. Ford, Guillermo Márquez, Steven M. Moore, Peter Ohan, Steven Peace, Jennifer L. Rosenbaum, Richard Barr, Robert C. Young, David Alberts, David DeMets, Peter Greenwald, Paula Jacobs, Theresa C. McLoud, David P. Naidich, James Tatum, Edward A. Sausville, Wylie Burke, Gene Colice, Brenda Edwards, Scott Emerson, John Fletcher, Sylvan Green, Russell Harris, Jeffrey S. Klein, Edward L. Korn, Robert Mayer, Joe V. Selby, David W. Sturges, Bruce W. Turnbull, Thomas J. Watson, Stephen Baylin, Neil Caporaso, Philip Dennis, Steve Dubinett, Wilbur Franklin, William Grizzle, Fred Hirsch, Pierre Massion, Kathy McKeeta-Frobeck, John Minna, Edward Patz, Margaret Spitz, Christine B. Berg, Donald Corle, Ping Hu, Grant Izmirlian, Jennifer Gaegler, Susan Hoffman, Charles Jackson, Erin Lange, Evanthia Papadopoulos, Charles Apgar, Anna Boyle, Tom Caldwell, Nancy Fredericks, Deborah Harbison, Donna Hartfeil, Sharon Jones, Steve King, Irene Mahon, Rosa Medina, Cindy Masiejczyk, Peter Zamora, Hank Brastater, Vish Iyer, Jincy George, Dinakar Gopalakrishnan, Patricia Blair, Michael Bradley, Cheryl Crozier, Maria Oh, Nicole Spiese, Chris Steward, Mary Kelly-Truran, Tess Thompson, Erin Cunningham, Anthony Levering, Kathleen McMurtrie, Michael Nahill, Sharlene Snowden, Kesha Smith, Fraser Wilton, Timothy Welsh, Rex Welsh, Wendell Christie, Stephanie Clabo, Roberta Clune, Natalie Cunningham, Jamie Downs, Lindsey Dymond, Julianne Falcone, Shani Harris, Pamela Harvey, Jane Hill, Laura Hill, Donna Letizia, Kendrick Looney, Hugh McGinley, Angelee Mean, Marcella Moore, Ryan Norton, Valentina Ortico, Sophia Sabina, Robert Sole, Jo Ann Stetz, Arnold Ssali, John Stubblefield, Tina Taylor, Shovonna White, Bo Lu, Amanda Adams, Sarah Baum, Meridith Blevins, Patricia Fox, Vincent Girardi, Jeremy Gorelick, Edward Hunt, Quentin McMullen, Karthikeyan Meganathan, Regina Rendas-Baum, Jo Rean D. 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Research output: Contribution to journalArticle

623 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)243-253
Number of pages11
JournalRadiology
Volume258
Issue number1
DOIs
StatePublished - Jan 1 2011

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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    Gatsonis, C. A., Aberle, D. R., Berg, C. D., Black, W. C., Church, T. R., Fagerstrom, R. M., Galen, B., Gareen, I. F., Goldin, J., Gohagan, J. K., Hillman, B., Jaffe, C., Kramer, B. S., Lynch, D., Marcus, P. M., Schnall, M., Sullivan, D. C., Sullivan, D., Zylak, C. J., ... Dyer, S. (2011). The national lung screening trial: Overview and study design. Radiology, 258(1), 243-253. https://doi.org/10.1148/radiol.10091808