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Goo: Lung Cancer Screening with Low-Dose CT: Current Statusin Other Countries
Review Article

J Korean Soc Radiol 2019;80(5):849-859.

Published online: 20 January 2019

DOI: https://doi.org/10.3348/jksr.2019.80.5.849

Lung Cancer Screening with Low-Dose CT: Current Statusin Other Countries

Jin Mo Goo, MD1, 2, ∗

1Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

2Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea

∗Corresponding author Jin Mo Goo, MD Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel 82-2-2072-2624 Fax 82-2-743-6385 E-mail jmgoo@plaza.snu.ac.kr

Received 22 April 2019       Revised 23 May 2019       Accepted 29 May 2019

Copyright © 2019 The Korean Society of Radiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lung cancer is the leading cause of death from cancer worldwide. The most effective way to reduce lung cancer mortality is early detection and treatment. Two large randomized controlled trials (RCTs), the National Lung Screening Trial and the Dutch-Belgian Randomized Lung Cancer Screening Trial, showed that low-dose CT (LDCT) can reduce the chances of lung cancer death. This paper reviews the two aforementioned RCTs and the current situations of implementing LDCT screening in several counties. Although nationwide programs of lung cancer screening are rare, they would increase in the near future. Using the two aforementioned RCTs and accumulating data from many counties, including the East Asian countries, a more effective way of LDCT screening in Korea can be devised and implemented.

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Table 1.
Randomized Controlled Trials of Lung Cancer Screening with LDCT
  NLST MILD DANTE ITALUNG DLCST NELSON LUSI UKLS
Country USA Italy Italy Italy Denmark Netherlands/ Belgium Germany UK
Centers Multicenter (33 sites) Single (originally multicenter design) Single Multicenter (3 sites) Single Multicenter (4 sites) Single Multicenter (2 sites)
Entry period 2002–2004 2005–2011 2001–2006 2004–2006 2004–2006 2003–2006 2007–2011 2011–Present
Total enrolled 53454 4099 2450 3206 4104 15792 4502 4055
Gender (M/F) 59/41 66/34 100/0 65/35 55/45 84/16 65/35 75/25
Age (years) 55–74 ≥ 49 60–74 55–69 50–70 50–74 50–69 50–75
Smoking 30 PY, current or quit within 15 years 20 PY, current or quit within 10 years 20 PY, current or quit within 10 years 20 PY, current or quit within 10 years 20 PY, current or quit within 10 years 3/4 pack × 25 years or 1/2 pack × 30 years, current or quit within 10 years 15 PY, current or quit within 10 years, 5% risk of developing lung cancer in 5 years
Screen arm LDCT (26722) Annual LDCT (1190)/ Biennial LDCT (1186) LDCT (1264) LDCT (1613) LDCT (2052) within 10 years LDCT (7900) LDCT (2029) LDCT (2028)
MDCT no. of rows At least 4 6–16 1, 16 1, 16 16 16, 64 16, 128 16
Section thickness (mm) 1–3.2 1 5 1 and 3 1 and 3 1 1 1 and 5
Control arm CXR (26732) Usual care (1723) Usual care (1186) Usual care (1593) Usual care (2052) Usual care (7892) Usual care (2023) Usual care (2027)
No. of screens (intervals) 3 (0, 1, 2 years) Median (5, annual; 3, biennial) 5 (0, 1, 2, 3, 4 years) 4 (0, 1, 2, 3 years) 5 (0, 1, 2, 3, 4 years) 4 (0, 1, 3, 5.5 years) 5 (0, 1, 2, 3, 4 years) 1
HR for lung cancer mortality (95% CI) 0.80 (0.70–0.92), p = 0.004 1.52 (0.63–3.65) p = 0.21 at 5 year; 0.61 (0.39–0.95), p = 0.02 at 10 year 0.99, (0.69–1.43) 0.70 (0.47–1.03), p = 0.07 1.03 (0.66–1.6), p = 0.888 M: 0.74 (0.69–0.91),p = 0.003/ F: 0.61 (0.35–1.04),p = 0.0543 NA NA

으로 보고되었다. NLST 결과를 바탕으로 한 비용-효과 분석에서는 생존연수(life-year gained)당 점증적 비용효과비(incremental cost-effectiveness ratio; ICER)는 52000불, 질보정수명(quality-adjusted life-year gained; QALY) 1년당 소요되는 비용은 81000불로 보고되었다(10). CI = confidence interval, CXR = chest X-ray, DANTE = Detection and Screening of Early Lung Cancer by Novel Imaging Technology and Molecular Essays, DLCST = Danish Lung Cancer Screening Trial, F = female, HR = hazard ratio, LDCT = low-dose CT, LUSI = Lung Cancer Screening Intervention Trial, M = male, MDCT = multidetector-row CT, MILD = Multicentric Italian Lung Detection, NA = not applicable, NELSON = Nederlands-Leuvens Longkanker Screenings Onderzoek, NLST = National Lung Screening Trial, PY = pack-year, UKLS = UK Lung Cancer Screening Trial

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