The Danish Randomized Lung Cancer CT Screening Trial—Overall Design and Results of the Prevalence Round

• Published in: Journal of thoracic oncology Vol. 4; no. 5; pp. 608 - 614
• Main Authors: Pedersen, Jesper H., Ashraf, Haseem, Dirksen, Asger, Bach, Karen, Hansen, Hanne, Toennesen, Phillip, Thorsen, Hanne, Brodersen, John, Skov, Birgit Guldhammer, Døssing, Martin, Mortensen, Jann, Richter, Klaus, Clementsen, Paul, Seersholm, Niels
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2009; International Association for the Study of Lung Cancer
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adult; Aged; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; Computed tomography; Denmark - epidemiology; Early Detection of Cancer; Epidemiologic Research Design; False Positive Reactions; Female; Humans; Lung cancer; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Male; Mass Screening; Middle Aged; Neoplasm Staging; Prevalence; Prognosis; Randomized clinical trial; Screening; Sensitivity and Specificity; Smoking - epidemiology; Tomography, X-Ray Computed; Screening; CT; Randomized clinical trial; Computed tomography; Lung cancer
• ISSN: 1556-0864; 1556-1380
• DOI: 10.1097/JTO.0b013e3181a0d98f

Lung cancer screening with low dose computed tomography (CT) has not yet been evaluated in randomized clinical trials, although several are underway. In The Danish Lung Cancer Screening Trial, 4104 smokers and previous smokers from 2004 to 2006 were randomized to either screening with annual low dose CT scans for 5 years or no screening. A history of cigarette smoking of at least 20 pack years was required. All participants have annual lung function tests, and questionnaires regarding health status, psychosocial consequences of screening, smoking habits, and smoking cessation. Baseline CT scans were performed in 2052 participants. Pulmonary nodules were classified according to size and morphology: (1) Nodules smaller than 5 mm and calcified (benign) nodules were tabulated, (2) Noncalcified nodules between 5 and 15 mm were rescanned after 3 months. If the nodule increased in size or was larger than 15 mm the participant was referred for diagnostic workup. At baseline 179 persons showed noncalcified nodules larger than 5 mm, and most were rescanned after 3 months: The rate of false-positive diagnoses was 7.9%, and 17 individuals (0.8%) turned out to have lung cancer. Ten of these had stage I disease. Eleven of 17 lung cancers at baseline were treated surgically, eight of these by video assisted thoracic surgery resection. Screening may facilitate minimal invasive treatment and can be performed with a relatively low rate of false-positive screen results compared with previous studies on lung cancer screening.