National Lung Screening Trial results hold true after 8 years

Nichole T. Tanner, MD, MSCR, FCCP
Nichole T. Tanner, MD, MSCR, FCCP

It’s been 8 years since the landmark National Lung Screening Trial (NLST) demonstrated mortality reduction from screening with low-dose CT scans. And this year, the NELSON trial results confirmed the benefit of screening. Nichole T. Tanner, MD, MSCR, FCCP, and her co-presenters will be going into more detail of how far we’ve come in lung cancer screening during Updates in Lung Cancer Screening: Eight Years Beyond the NLST on Sunday at 4:45 pm in room 281 of the convention center.

Dr. Tanner, associate professor of medicine and co-director of the lung cancer screening program at the Hollings Cancer Center in the division of pulmonary, critical care, allergy, and sleep medicine at Medical University of South Carolina and the Ralph H. Johnson VA Medical Center, provided a glimpse of the session topics in this Daily News Q&A.

How was the NLST monumental at the time and how did it change things?

→ The NLST was transformative because it provided the evidence in support for lung cancer screening with low-dose CT scan in those at highest risk for lung cancer based on age and smoking history. Prior to this landmark trial, there were no effective means to screen for lung cancer, which kills more Americans annually than breast, colon, and prostate cancer combined. This is because at the time of presentation, most are diagnosed with advanced stage disease that is less likely to be cured. The premise for lung cancer screening is early detection and improved survival.

What progress has been made on the implementation of lung cancer screening?

→ Since the publication of the NLST, implementation and uptake of lung cancer screening has been slow, with only 3.9% of the eligible population being screened in 2015. This may be in part because lung cancer screening was not endorsed by the U.S. Preventive Services Task Force until 2013 and was not a covered benefit by the Centers for Medicare & Medicaid (CMS) until 2015. Many sites were awaiting insurance coverage before embarking on implementation. An additional consideration for low uptake is that this is the first time that individuals are being offered a screening test not only because of age but because of a poor health behavior choice (eg, smoking). Prior studies have shown that smokers are a harder-to-reach population and are less likely to undergo screening for other cancers or want treatment for a screen-detected lung cancer compared with nonsmokers. There has been a number of policy statements endorsed by CHEST and others that highlight the components needed for an effective and high-quality lung cancer screening program. Practical publications on the phases of lung cancer screening implementation also have been published to highlight considerations for planning, implementing, and maintaining a lung cancer screening program.

What are the results of the NELSON trial and how do they confirm the benefit of screening?

→ To date, the results available from the NELSON trial are only available in abstract form. From what is available, the NELSON trial demonstrated a 30% reduction in lung cancer mortality in the screened arm with more benefit seen in women.

What are some of the controversial topics and unknowns you’ll be addressing in your session?

→ We will discuss comorbidities and competing causes of death in patient selection, disparities in lung cancer screening, risk-based screening, and adherence to annual screening. We also will discuss disparities around lung cancer screening and potential ways to improve these.

What are the goals/key takeaways?

→ We have come a long way since the publication of the NLST, and much work has been done to show how inclusion criteria can be further refined and which populations may benefit the most from lung cancer screening. How to incorporate competing causes of death into patient selection is both difficult and important. Addressing disparities to improve the reach of lung cancer screening is also imperative. Lastly, once a person has a baseline screening exam, adherence with follow-up testing in subsequent years is needed to ensure the most benefit from lung cancer screening will be had.