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Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis
John K Field1, Daniel Vulkan2, Michael P A Davies1
1Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK.
Background:
The NLST reported a significant 20% reduction in lung cancer mortality with three annual low-dose CT (LDCT) screens and the Dutch-Belgian NELSON trial indicates a similar reduction. We present the results of the UKLS trial.
Methods:
From October 2011 to February 2013, we randomly allocated 4 055 participants to either a single invitation to screening with LDCT or to no screening (usual care). Eligible participants (aged 50-75) had a risk score (LLPv2) ≥ 4.5% of developing lung cancer over five years. Data were collected on lung cancer cases to 31 December 2019 and deaths to 29 February 2020 through linkage to national registries. The primary outcome was mortality due to lung cancer. We included our results in a random-effects meta-analysis to provide a synthesis of the latest randomised trial evidence.
Findings:
1 987 participants in the intervention and 1 981 in the usual care arms were followed for a median of 7.3 years (IQR 7.1-7.6), 86 cancers were diagnosed in the LDCT arm and 75 in the control arm. 30 lung cancer deaths were reported in the screening arm, 46 in the control arm, (relative rate 0.65 [95% CI 0.41-1.02]; p=0.062). The meta-analysis indicated a significant reduction in lung cancer mortality with a pooled overall relative rate of 0.84 (95% CI 0.76-0.92) from nine eligible trials.
Interpretation:
The UKLS trial of single LDCT indicates a reduction of lung cancer death of similar magnitude to the NELSON and NLST trials and was included in a meta-analysis of nine randomised trials which provides unequivocal support for lung cancer screening in identified risk groups.
Funding:
NIHR Health Technology Assessment programme; NIHR Policy Research programme; Roy Castle Lung Cancer Foundation.
Insights
The UK Lung Cancer Screening (UKLS) trial showed that a single low-dose CT (LDCT) screen reduced lung cancer deaths. This finding, combined with other trials, strongly supports lung cancer screening for high-risk individuals.
Area of Science:
- Oncology
- Radiology
- Public Health
Background:
- Lung cancer screening trials like NLST and NELSON have shown significant mortality reductions.
- The UK Lung Cancer Screening (UKLS) trial aimed to evaluate the effectiveness of low-dose CT (LDCT) screening.
Purpose of the Study:
- To assess the impact of a single low-dose CT (LDCT) screening invitation on lung cancer mortality.
- To synthesize evidence from randomized trials on lung cancer screening effectiveness.
Main Methods:
- Randomly allocated 4,055 participants (aged 50-75 with a 5-year lung cancer risk score ≥4.5%) to LDCT screening or usual care.
- Collected data on lung cancer diagnoses and deaths through national registries until December 2019/February 2020.
- Conducted a random-effects meta-analysis including the UKLS trial and eight other eligible randomized trials.
Main Results:
- The UKLS trial showed a trend towards reduced lung cancer mortality in the LDCT arm (relative rate 0.65, p=0.062).
- A meta-analysis of nine trials, including UKLS, indicated a significant overall reduction in lung cancer mortality (pooled relative rate 0.84).
Conclusions:
- A single LDCT screening in the UKLS trial demonstrated a lung cancer mortality reduction comparable to previous trials.
- The combined evidence from nine randomized trials provides strong support for lung cancer screening in individuals identified as high-risk.
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