NELSON lung cancer screening study reinforces need for widespread testing

Findings from the NELSON study, presented at the International Association for the Study of Lung Cancer (IASLC) World Conference on Lung Cancer, reinforced the belief that the annual screening of older-aged current and former smokers should be conducted more widely.

Widespread screening could potentially save up to 65,000 lives in the US each year, according to study authors.

“Lung cancer kills more people each year than breast, colon and prostate cancers combined. Once implemented nationwide, this cost-efficient test would be the most effective cancer screening exam in history,” said Ella Kazerooni, MD, FACR, chair of the American College of Radiology (ACR) Lung Cancer Screening Committee and ACR Thoracic Imaging Panel, in a prepared statement issued by the ACR. “It is time for Medicare to provide adequate reimbursement for these exams, and for primary care providers and thoracic specialists to order them for their high-risk patients.”

The NELSON study was a population-based, controlled trial that enrolled 15,792 individuals. Participants were either part of the study arm or the control arm. Study arm participants were given CT screenings at baseline, and one, three and five and one-half years post-randomization. No screenings were offered to control arm participants.

Results of the study showed annual lung cancer screening with low-dose CT in high-risk patients reduced lung cancer deaths by 26 percent in men and up to 61 percent in women. There was a 44 percent reduction overall if male and female cohorts were evenly split, the statement read.

“These findings show that CT screenings are an effective way to assess lung nodules in people at high risk for lung cancer, often leading to detection of suspicious nodules and subsequent surgical intervention at relatively low rates and with few false positives and can positively increase the chances of cure in this devastating disease,” said Harry J. De Koning, MD, PhD, of Erasmus MC in Rotterdam, Netherlands, in a prepared statement issued by the IASLC. “It is the second largest trial in the world, with an even more favorable outcome than the first trial, the NLST, showed. These results should be used to inform and direct future CT screening in the world.”

In addition to wider screening, the NELSON study also reinforces that medical providers become familiar with lung cancer screening guidelines and prescribe exams for appropriate high-risk patients. Additionally, there should be an increase in Medicare reimbursement to support widespread screening.

“Shortly after covering these exams, the Centers for Medicare & Medicaid Services (CMS) slashed Medicare reimbursement to as little as $60 per exam in the hospital outpatient setting—less than half the Medicare provider reimbursement for a mammogram,” the ACR statement read. “This has restricted the number of facilities able to provide these lifesaving scans to large teaching hospitals. Funding for lung cancer screening needs to be greatly increased.”