NELSON Trial Reinforces Efficacy of Low-Dose CT Lung Cancer Screening

The decline in death rate for cancer overall has been steady over the past two decades. Yet lung cancer remains the leading cause of cancer deaths. The most likely reason: delayed detection. The fact remains that approximately 55% of lung cancer patients have advanced disease at the time of diagnosis, which, as you know, makes them more challenging to treat effectively.

Making a Stronger Case for Screening

We know, based on the results of the National Lung Screening Trial (NLST), that low-dose CT lung cancer screening has the ability to reduce lung cancer mortality by 20 percent. That study was published more than a decade ago. But today, only around 4 to 6% of people eligible for lung cancer screening are actually getting screened.

A more recent study published in the New England Journal of Medicine earlier this year — the Dutch-Belgian lung cancer screening trial (Nederlands–Leuvens Longkanker Screenings Onderzoek [NELSON] — makes the case even stronger for the use of low-dose CT lung cancer screening. “This study was more advanced and broader than the National Lung Screening Trial,” says thoracic surgeon Linda Martin, MD, MPH. “This study included four different screening tests and patients were followed for 10 years compared to six. The participants were a little younger and the smoking criteria was less stringent, so it was more inclusive.”

Another difference between the two studies: NELSON compared low-dose CT screening to no screening whereas the NLST compared CT screening to chest X-ray. “Chest X-ray is not recommended for lung cancer screening, so the NELSON study was closer to reality — either you get screened or you don’t,” says Martin.

The results showed a 24% reduction in lung cancer death overall and a 33% reduction in women; this is compared to a 20% reduction in mortality in the NLST. “This is a real finding substantiated in another really big trial,” says Martin. “I’m hoping that this study will have an impact and everyone will get on board with utilizing low-dose CT lung cancer screening.”

Who Should Be Screened

According to the US Preventive Services Task Force (USPSTF), asymptomatic patients who meet the following criteria should be screened for lung cancer using low-dose CT scanning:

  • Are between the ages of 55 and 80
  • Have smoked equal to one pack a day for 30 years, or two packs a day for 15 years, etc.
  • Are current smokers or have quit within the past 15 years

However, based on the NELSON study findings, these criteria may change, according to Aimee Strong, DNP, program coordinator for UVA’s Lung Cancer Screening Program. “The USPSTF has proposed major changes to the current lung cancer screening guidelines. These changes include lowering the screening age to 50 and decreasing the pack years from 30 to 20,” says Strong. “These changes will allow us to screen more patients, particularly African Americans and women who have been shown to develop lung cancer at earlier ages and with less of a smoking history. This provides us with an opportunity to make even more of a difference in mortality with screening,” she says.

The USPSTF and the National Comprehensive Cancer Network may get on board with broadening criteria, but it will take time for insurance companies to follow suit. “Hopefully there is now renewed momentum and people will be pushing to move as fast as possible to make this screening technique more widely available,” says Strong.

To refer a patient for lung cancer screening, call UVA Physician Direct at 800.552.3723.