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National Lung Screening Trial findings by age: Medicare-eligible versus under-65 population.

Publication ,  Journal Article
Pinsky, PF; Gierada, DS; Hocking, W; Patz, EF; Kramer, BS
Published in: Ann Intern Med
November 4, 2014

BACKGROUND: The NLST (National Lung Screening Trial) showed reduced lung cancer mortality in high-risk participants (smoking history of ≥30 pack-years) aged 55 to 74 years who were randomly assigned to screening with low-dose computed tomography (LDCT) versus those assigned to chest radiography. An advisory panel recently expressed reservations about Medicare coverage of LDCT screening because of concerns about performance in the Medicare-aged population, which accounted for only 25% of the NLST participants. OBJECTIVE: To examine the results of the NLST LDCT group by age (Medicare-eligible vs. <65 years). DESIGN: Secondary analysis of a group from a randomized trial (NCT00047385). SETTING: 33 U.S. screening centers. PATIENTS: 19 612 participants aged 55 to 64 years (under-65 cohort) and 7110 participants aged 65 to 74 years (65+ cohort) at randomization. INTERVENTION: 3 annual rounds of LDCT screening. MEASUREMENTS: Demographics, smoking and medical history, screening examination adherence and results, diagnostic follow-up procedures and complications, lung cancer diagnoses, treatment, survival, and mortality. RESULTS: The aggregate false-positive rate was higher in the 65+ cohort than in the under-65 cohort (27.7% vs. 22.0%; P < 0.001). Invasive diagnostic procedures after false-positive screening results were modestly more frequent in the older cohort (3.3% vs. 2.7%; P = 0.039). Complications from invasive procedures were low in both groups (9.8% in the under-65 cohort vs. 8.5% in the 65+ cohort). Prevalence and positive predictive value (PPV) were higher in the 65+ cohort (PPV, 4.9% vs. 3.0%). Resection rates for screen-detected cancer were similar (75.6% in the under-65 cohort vs. 73.2% in the 65+ cohort). Five-year all-cause survival was lower in the 65+ cohort (55.1% vs. 64.1%; P = 0.018). LIMITATION: The oldest screened patient was aged 76 years. CONCLUSION: NLST participants aged 65 years or older had a higher rate of false-positive screening results than those younger than 65 years but a higher cancer prevalence and PPV. Screen-detected cancer was treated similarly in the groups. PRIMARY FUNDING SOURCE: National Institutes of Health.

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Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

November 4, 2014

Volume

161

Issue

9

Start / End Page

627 / 633

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Survival Analysis
  • Smoking
  • Pneumonectomy
  • Neoplasm Staging
  • Middle Aged
  • Lung Neoplasms
  • Lung
  • Humans
  • General & Internal Medicine
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Pinsky, P. F., Gierada, D. S., Hocking, W., Patz, E. F., & Kramer, B. S. (2014). National Lung Screening Trial findings by age: Medicare-eligible versus under-65 population. Ann Intern Med, 161(9), 627–633. https://doi.org/10.7326/M14-1484
Pinsky, Paul F., David S. Gierada, William Hocking, Edward F. Patz, and Barnett S. Kramer. “National Lung Screening Trial findings by age: Medicare-eligible versus under-65 population.Ann Intern Med 161, no. 9 (November 4, 2014): 627–33. https://doi.org/10.7326/M14-1484.
Pinsky PF, Gierada DS, Hocking W, Patz EF, Kramer BS. National Lung Screening Trial findings by age: Medicare-eligible versus under-65 population. Ann Intern Med. 2014 Nov 4;161(9):627–33.
Pinsky, Paul F., et al. “National Lung Screening Trial findings by age: Medicare-eligible versus under-65 population.Ann Intern Med, vol. 161, no. 9, Nov. 2014, pp. 627–33. Pubmed, doi:10.7326/M14-1484.
Pinsky PF, Gierada DS, Hocking W, Patz EF, Kramer BS. National Lung Screening Trial findings by age: Medicare-eligible versus under-65 population. Ann Intern Med. 2014 Nov 4;161(9):627–633.

Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

November 4, 2014

Volume

161

Issue

9

Start / End Page

627 / 633

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Survival Analysis
  • Smoking
  • Pneumonectomy
  • Neoplasm Staging
  • Middle Aged
  • Lung Neoplasms
  • Lung
  • Humans
  • General & Internal Medicine