Editorials

Lung cancer screening with low dose computed tomography

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1970 (Published 07 March 2014) Cite this as: BMJ 2014;348:g1970
  1. David R Baldwin, consultant respiratory physician1,
  2. David M Hansell, professor of thoracic imaging2,
  3. Stephen W Duffy, professor of cancer screening3,
  4. John K Field, director of research, Roy Castle Research Programme4
  1. 1Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, Nottingham NG5 1PB, UK
  2. 2Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  3. 3Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  4. 4Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, Liverpool, UK
  1. david.baldwin{at}nuh.nhs.uk

Now recommended in the US, but what about the UK?

Lung cancer is a health problem that clearly merits a screening programme. Each year about 35 000 people in the United Kingdom die from lung cancer—more than the number for colorectal and breast cancer combined. In addition, about three quarters of people present with incurable disease, at a stage when treatment has little effect on overall survival; early stage disease is curable; risk factors for lung cancer are well understood; and a highly sensitive screening test is available.

Many of the early trials of screening with chest radiography and the non-randomised computed tomography studies were not designed to minimise the biases operating in screening trials that result in apparently longer survival but no reduction in mortality. The answer to this problem was to design randomised controlled trials with disease specific mortality as the endpoint.

The National Lung Screening Trial (NLST) randomised more than 53 400 people in the United States aged 55-74 years who had smoked in the past 15 years and had accumulated a minimum of 30 pack years to three annual screens with low dose computed tomography or chest radiography.1 The trial recruited between 2002 and 2004, and in October 2010 …

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