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

NELSON was the European counterpart to NLST, using volume-based CT screening (rather than diameter-based) and a longer follow-up period (10 years).

Multicenter RCT (Netherlands and Belgium, n=15,792 men) comparing volume CT screening (at 1, 3, 5.5 years) vs. no screening in high-risk smokers.

CT screening reduced lung cancer mortality by 24% in men at 10 years (2.50 vs 3.30 per 1,000 person-years). In women (smaller subgroup), mortality reduction was 33–39%. Fewer false positives than NLST due to volume-based nodule assessment.

NELSON confirms NLST findings with longer follow-up and a European population. Volume-based nodule assessment (rather than diameter) reduces false positives. Combined with NLST, CT screening is strongly supported for high-risk smokers. USPSTF 2021 criteria: age 50–80, ≥20 pack-years, current or quit <15 years.

Predominantly male population. Volume-based CT not universally available. Overdiagnosis remains a concern.