The Journal of Thoracic and Cardiovascular Surgery
Thoracic: Lung CancerOverestimation of screening-related complications in the National Lung Screening Trial
Graphical abstract
Section snippets
National Lung Screening Trial
The randomized controlled National Lung Screening Trial (NLST) enrolled 53,454 individuals from 33 US medical centers who were deemed high risk for developing lung cancer in the period from August 2002 to April 2004. Enrolled individuals were 55 to 74 years of age and were current or former smokers who quit within the prior 15 years with at least 30 pack/year history of cigarette smoking at the time of randomization. Individuals who had symptoms of lung cancer, a history of lung cancer, or
Results
The NLST dataset used in this study included 53,452 individuals who underwent lung cancer screening with LDCT (n = 26,722) or CXR (n = 26,730). Of those, 2058 patients were diagnosed with lung cancer (LDCT arm [n = 1089]; CXR arm [n = 969]) (Table 1).
Discussion
This study is an in-depth analysis of the invasive procedures performed and the rate of related adverse effects in patients enrolled in the NLST who underwent lung cancer screening. Although the potential risk of complications related to invasive procedures is often listed as a harm of LDCT lung cancer screening, the actual nature and extent of those complications and their relationship to the final diagnosis of screened individuals have not been fully described.
In this study, the rates of
Conclusions
We provide a detailed analysis of the risk of complications in patients who underwent screening in the NLST and demonstrate that the rates of intermediate and major complications among patients who do not have lung cancer are remarkably low. Permanent or debilitating complications are exceedingly rare. Standardized approaches to nodule investigation and expanded use of minimally invasive surgical techniques will likely decrease screening-related morbidity even further. We hope that these
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Commentary: Prevention is possible: Our responsibility is real
2023, Journal of Thoracic and Cardiovascular Surgery