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Lung cancer screening with low-dose CT (LDCT), or when a public health intervention is beyond the patient’s benefit
  1. Alberto Ruano-Ravina1,2,
  2. Bruno Heleno3,
  3. Alberto Fernández-Villar4
  1. 1Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
  2. 2CIBER de Epidemiología y Salud Pública, CIBERESP, Barcelona, Spain
  3. 3Department of Public Health, Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen, Denmark
  4. 4Service of Pneumology, University Hospital Complex of Vigo, Vigo, Spain
  1. Correspondence to Professor Alberto Ruano-Ravina, Department of Preventive Medicine and Public Health, School of Medicine, University of Santiago de Compostela, C/San Francisco s/n, Santiago de Compostela 15782, Spain; alberto.ruano{at}usc.es

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Lung cancer is the main cause of cancer death in the developed world. It is also the second most incident cancer in males and the third in females. Tobacco is its main risk factor, with 90% of all LC deaths attributable to tobacco consumption. It has a 13% 5-year survival,1 and more than 60% of all LCs are diagnosed in advanced stages. To reduce the burden of disease, it would be very important to have a screening test that is able to: (1) detect LC at an early stage to modify its prognosis, (2) present a low percentage of false-positives, to avoid unnecessary harms, (3) minimise adverse effects for the patient (ie, cancer-induced radiation) and (4) be cost-effective for the health system.

Screening effectiveness is being assessed in randomised trials. There are seven ongoing trials comparing low-dose CT (LDCT) with usual care.2 The only trial which has published final incidence and mortality results is the National Lung Screening Trial (NLST), which compared LDCT versus chest X-ray (CXR).3 The NLST has the highest sample size to date and there are no forthcoming trials with higher sample sizes. It included individuals aged between 55–74 years who had smoked at least 30 pack-years, and ex-smokers with less than 15 years since quitting. It found a 20% relative risk reduction in LC mortality and a 6.7% reduction in all-cause mortality. For each 1000 participants in the trial, LDCT avoids 5 deaths of which 3 are due to LC. The NLST was a well-designed study including more than 53 000 participants with three screening rounds and an extra follow-up of 5 years after the screening stopped.

These results have encouraged many scientific societies to recommend LC screening …

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