Letter to the Editor
The National Lung Screening Trial. A Before and After in Lung Cancer Screening With Low-Dose Computed Tomography
El National Lung Screening Trial. Un antes y un después en el cribado de cáncer de pulmón con tomografía computarizada de baja dosis
Luis Gorospe
Departamento de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain
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View the defect on chest CT (mediastinal window): (C) coronal slice; (D) axial slice.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elisabet Arango Tomás, Carlos Baamonde Laborda, Javier Algar Algar, Angel Salvatierra Velázquez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Elisabet" "apellidos" => "Arango Tomás" ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Baamonde Laborda" ] 2 => array:2 [ "nombre" => "Javier" "apellidos" => "Algar Algar" ] 3 => array:2 [ "nombre" => "Angel" "apellidos" => "Salvatierra Velázquez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289613000264" "doi" => "10.1016/j.arbres.2013.01.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289613000264?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212913001432?idApp=UINPBA00003Z" "url" => "/15792129/0000004900000010/v1_201309260158/S1579212913001432/v1_201309260158/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "The <span class="elsevierStyleItalic">National Lung Screening Trial</span>. A Before and After in Lung Cancer Screening With Low-Dose Computed Tomography" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "453" "paginaFinal" => "454" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Luis Gorospe" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Luis" "apellidos" => "Gorospe" "email" => array:1 [ 0 => "luisgorospe@yahoo.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El <span class="elsevierStyleItalic">National Lung Screening Trial</span>. Un antes y un después en el cribado de cáncer de pulmón con tomografía computarizada de baja dosis" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">As a radiologist, I would like to congratulate the authors of the article “Lung Cancer Screening with Low-Dose Computed Tomography after the National Lung Screening Trial. The Debate is Still Open” for their comprehensive review of this topical controversial issue, and to express my agreement with most of their arguments, particularly with regard to the idea that an early lung cancer detection program with low-dose computed tomography (LDCT) should be studied as part of a structured and multidisciplinary process.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There are, however, some inconsistencies between the title of the article, which appears to recognize the landmark represented by the National Lung Screening Trial (NLST) and the recommendations made by the authors based on the heterogeneous characteristics and varying results of the different lung cancer screening programs carried out to date. Some of the data reported by the authors (referring to radiation exposure or the LDCT slice thickness, for example) which they appear to use as the basis of some of their recommendations are questionable, or at least, more typical of the earliest screening studies and unacceptable according to the standards established by the NLST.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a> With regard to the economic impact, there are preliminary data suggesting that an early lung cancer detection program with LDCT would not only cost less than other widely accepted cancer screening programs (cervical, breast), but that in comparison with these other cancers, the cost per life-year saved would also be more favorable.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">As the first randomized clinical trial to show a reduction in lung cancer-specific mortality of 20.3% in a high-risk population, the design and results of the NLST represent a turning point. Although there are still questions to be answered and areas for improvement, the principal conclusion of the NLST is that LDCT screening in a certain risk group reduces lung cancer mortality. Most previous clinical trials (with suboptimal designs and smaller study populations) have shown that LDCT is a useful diagnostic tool for the early detection of lung tumors in subjects at risk, but these studies lack the consistency and quality of the NLST. Accordingly, I believe that the real point of departure for making updated recommendations for a hypothetical lung cancer screening program must be the NLST.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The authors’ comment saying “…we do not recommend lung cancer screening with CT for smokers or ex-smokers outside of the context of individual counseling” is not consistent with the primary conclusion of the NLST (the reduction of lung cancer-specific mortality with LDCT screening in a specific risk group), particularly when the title of the article appears to recognize the importance of this trial. Indeed, what the NLST has come to show (and its results have been quickly translated into the clinical practice guidelines of several American scientific societies) is that LDCT screening of a specific risk group reduces lung cancer mortality, and so could be implemented within a structured, multidisciplinary program guaranteeing comparable results.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The professionals involved (and the selected participants) must be aware of the potential risks and benefits of a screening program of these characteristics, but in the end it will be the participant who decides to use the program or not.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The recommendation of the authors to “unite our efforts to make sure that healthcare professionals are alerted to lung cancer symptoms, while improving their training and making smokers aware of the risk they have for developing lung cancer” is insufficient if the aim is to achieve early detection of this disease and reduce mortality. In some countries there are already more ex-smokers than active smokers who meet NLST criteria, so excluding the growing population who have quit smoking but who still have an increased risk of developing lung cancer does not seem to be a very advisable measure.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The debate is not only still open, but must remain open and receptive to the scientific evidence and opinions that will ultimately determine whether LDCT has a significant role in the early detection of lung cancer.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">I declare that I have no conflict of interest nor have I received funding from any sources.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gorospe L. El <span class="elsevierStyleItalic">National Lung Screening Trial</span>. Un antes y un después en el cribado de cáncer de pulmón con tomografía computarizada de baja dosis. Arch Bronconeumol. 2013;49:453–4.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cribado de cáncer de pulmón con tomografía computarizada de baja dosis después del <span class="elsevierStyleItalic">National Lung Screening Trial.</span> El debate continúa abierto" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Ruano-Ravina" 1 => "M. Pérez-Ríos" 2 => "A. Fernández-Villar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2013, January" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reduced lung-cancer mortality with low-dose computed tomographic screening" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "The National Lung Screening Trial Research Team" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1102873" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2011" "volumen" => "365" "paginaInicial" => "395" "paginaFinal" => "409" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21714641" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The National Lung Screening Trial: overview and study design" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "National Lung Screening Trial Research Team" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.10091808" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2011" "volumen" => "258" "paginaInicial" => "243" "paginaFinal" => "253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21045183" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Benefits and harms of CT screening for lung cancer. 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| 2017 May | 35 | 5 | 40 |
| 2017 April | 28 | 5 | 33 |
| 2017 March | 22 | 13 | 35 |
| 2017 February | 41 | 1 | 42 |
| 2017 January | 25 | 2 | 27 |
| 2016 December | 47 | 5 | 52 |
| 2016 November | 51 | 5 | 56 |
| 2016 October | 54 | 15 | 69 |
| 2016 September | 61 | 14 | 75 |
| 2016 August | 64 | 12 | 76 |
| 2016 July | 44 | 19 | 63 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 2 | 0 | 2 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 45 | 3 | 48 |
| 2015 September | 52 | 15 | 67 |
| 2015 August | 50 | 12 | 62 |
| 2015 July | 70 | 11 | 81 |
| 2015 June | 32 | 6 | 38 |
| 2015 May | 60 | 23 | 83 |
| 2015 April | 41 | 13 | 54 |
| 2015 March | 42 | 5 | 47 |
| 2015 February | 36 | 10 | 46 |
| 2015 January | 38 | 9 | 47 |
| 2014 December | 33 | 4 | 37 |
| 2014 November | 39 | 8 | 47 |
| 2014 October | 61 | 10 | 71 |
| 2014 September | 41 | 10 | 51 |
| 2014 August | 33 | 10 | 43 |
| 2014 July | 44 | 12 | 56 |
| 2014 June | 55 | 7 | 62 |
| 2014 May | 56 | 13 | 69 |
| 2014 April | 62 | 10 | 72 |
| 2014 March | 68 | 16 | 84 |
| 2014 February | 58 | 15 | 73 |
| 2014 January | 37 | 24 | 61 |
| 2013 December | 3 | 0 | 3 |
| 2013 November | 0 | 1 | 1 |
| 2013 October | 0 | 2 | 2 |
Show all
