15IN WHERE DO WE STAND ON SCREENING IN EUROPE?

Abstract

There are currently 6 randomised European lung cancer screening trials ongoing in which low-dose CT screening is compared with no screening. The NELSON trial (the Netherlands and Belgium) in which 15,750 participants have been enrolled. The 1st, 2nd and 3rd screening rounds have been completed and the 4th round will be completed in 2011. The 1st screening interval is one year, the 2nd 2 years and the 3rd 2.5 years. The DLCST (Denmark) randomised 4,104 participants. All 5 annual screening rounds have been completed. The DANTE trial (Italy) enrolled 1,276 participants to the screen and 1,196 to the control arm. Five annual screening rounds have also been completed. ITALUNGCT (Italy) randomised 1,613 participants to the screen and 1,593 to the control arm. Four annual screening rounds have been completed. The LUSI trial (Germany) has enrolled 3,551 of the planned 4,000 participants who will undergo 5 annual screening rounds. The MILD trial (Italy) randomised almost 3000 subjects so far. the UKLS trial (UK) will start soon with a pilot of 4,000 subjects follow by one single screening round for 32,000 participants. Even with the 32.000 subjects enrolled so far, we will have to wait until 2015 until a sufficient number of events have become available. Until then it might be possible to model a potential mortality reduction based on the stage distributions in both arms and the available mortality data. Even though the NLST trial showed a mortality reduction of 20% after 8 years of follow-up and an overall mortality reduction of 7%, outcome of the European trials is still very important because at least one conformation study is needed before CT screening can be recommended. European trials and specially the NELSON trial will be able to answer the question what the optimal number of screening rounds and duration of screen interval is. In addition, cost-effectiveness analyses have to be performed. From the NELSON trial we know that with the use of volumetry software the number of recall CT scans can be reduced substantially and that the proportion of test positive test results can be reduced to 2%. NELSON investigators also demonstrated that CT screening has no relevant impact on QOL and that 15% of the screen and control arm participants quit smoking. Disclosure: The author has declared no conflicts of interest.