Discover and read the best of Twitter Threads about #lungcancerscreening
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The all-cause mortality result in the NELSON #lungcancer screening trial has generated major debate.
How do we interpret this? Let's start with what we expected to observe.
@NEJM #lcsm #lungcancerscreening #EpiTwitter
How do we interpret this? Let's start with what we expected to observe.
@NEJM #lcsm #lungcancerscreening #EpiTwitter
NELSON showed a 24% statistically significant reduction in lung cancer mortality with low-dose CT screening in men.
If the intervention (screening) does not lead to fatal harms, then we expect the rate of death from other (non-lung-cancer) causes to be the same in both arms.
If the intervention (screening) does not lead to fatal harms, then we expect the rate of death from other (non-lung-cancer) causes to be the same in both arms.
Now, a large reduction in lung cancer mortality would translate to a small reduction in all-cause mortality, since lung cancer only causes a portion of deaths (see NLST).
NELSON did not have enough power to test whether the hazard ratio for all-cause mortality differed from 1.
NELSON did not have enough power to test whether the hazard ratio for all-cause mortality differed from 1.
People often tell me we should not fund #lungcancerscreening because its just for #smokers and they do this to themselves... No surprise for anyone associated with #lungcancer who know all too well bias and #stigma faced by those who suffer from it. This is what I tell them...
While smoking remains an individual action, the majority of smokers are hooked at a young age, often before age 18 (in Alberta, the avg age is 16). As one of the most addictive substances around, the argument that smoking is a simple informed choice made by adults is not valid.
Society must share the responsibility for their addiction & consequence from a legal product heavily marketed to population and easily accessed by youth despite regulations.
11 year follow-up of NLST #lungcancerscreening trial published online in @JTOonline
doi.org/10.1016/j.jtho…
Main findings as follows:
doi.org/10.1016/j.jtho…
Main findings as follows:
Overall increase in number of lung cancers between CXR (red) arm and LDCT (black) goes away, suggesting catch-up occurring in CXR arm. Still see an excess of "BAC" type cancers. 
Relative risk of lung cancer deaths decreases as move away from last screen, but Number-Needed-to-Screen still ~300, suggesting as per authors "that LDCT screening did not just delay lung cancer death by a few years, but prevented it, or at least delayed it for > than a decade"
