Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening (NLST)

Lung cancer is the leading cause of cancer death in the US. Prior chest X-ray screening trials showed no mortality benefit. NLST was the first large trial to test low-dose CT (LDCT) screening.

Multicenter RCT (n=53,454) comparing annual LDCT vs. chest X-ray for 3 years in high-risk smokers aged 55–74 with ≥30 pack-year history.

LDCT screening reduced lung cancer mortality by 20% (247 vs 309 deaths per 100,000 person-years, p=0.004) and all-cause mortality by 6.7%. 39.1% of LDCT screens were positive, but 96.4% of positive screens were false positives.

Annual LDCT screening is recommended for high-risk individuals (age 50–80, ≥20 pack-year history, current smoker or quit within 15 years per USPSTF 2021 criteria). This is now standard of care and covered by Medicare/Medicaid.

High false-positive rate (96.4%) leads to unnecessary follow-up procedures. Overdiagnosis is a concern. Results from academic centers may not generalize.