Downstream testing and interventions in the NLST
Principal Investigator
About this CDAS Project
Study
NLST
(Learn more about this study)
Project ID
NLST-95
Initial CDAS Request Approval
Nov 7, 2014
Title
Downstream testing and interventions in the NLST
Summary
Background and Significance
The National Lung Cancer Screening Trial (NLST) is the first randomized study to demonstrate reduction in lung cancer mortality from the use of a screening test. In the NLST, low dose spiral computed tomography scans were compared with chest radiography, and results indicated an 18% reduction in disease specific mortality and a 6% reduction in all cause mortality. [1] To date, the NLST is the first screening trial to show statistically significant differences in disease specific and all cause mortality.
Translating the results of the NLST into practice has proven contentious. Although analyses demonstrate a consistent effect of screening across included age groups[2], an external panel convened to advise a coverage decision for the Centers for Medicare and Medicaid Services (CMS) took a negative stance against funding screening in the Medicare population.
Some critics of the NLST cite the trial’s high false positive rate (~23%) as a limitation of screening. However, a detailed analysis of the downstream diagnostic tests and interventions following a positive screen in NLST has not yet been conducted . For this reason, we seek to provide a descriptive analysis of downstream testing in the NLST, as has been done previously for a smaller pilot study[3].
The National Lung Cancer Screening Trial (NLST) is the first randomized study to demonstrate reduction in lung cancer mortality from the use of a screening test. In the NLST, low dose spiral computed tomography scans were compared with chest radiography, and results indicated an 18% reduction in disease specific mortality and a 6% reduction in all cause mortality. [1] To date, the NLST is the first screening trial to show statistically significant differences in disease specific and all cause mortality.
Translating the results of the NLST into practice has proven contentious. Although analyses demonstrate a consistent effect of screening across included age groups[2], an external panel convened to advise a coverage decision for the Centers for Medicare and Medicaid Services (CMS) took a negative stance against funding screening in the Medicare population.
Some critics of the NLST cite the trial’s high false positive rate (~23%) as a limitation of screening. However, a detailed analysis of the downstream diagnostic tests and interventions following a positive screen in NLST has not yet been conducted . For this reason, we seek to provide a descriptive analysis of downstream testing in the NLST, as has been done previously for a smaller pilot study[3].
Aims
Specific Aims:
To characterize the frequency and timing of downstream testing including: biopsy, resection, other invasive procedures, CT scans, other imaging, sputum cytology, etc. based on characteristics of the initial positive scan (e.g. nodule size) also stratified by the first positive or subsequent scan.
Collaborators
Paul Pinsky PhD MPH, DCP