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Randomized Controlled Trial
. 2014 Nov 4;161(9):627-33.
doi: 10.7326/M14-1484.

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

Paul F Pinsky, David S Gierada, William Hocking, Edward F Patz Jr, Barnett S Kramer
Randomized Controlled Trial

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

Paul F Pinsky et al. Ann Intern Med. .

Abstract

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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All-cause survival among patients with screen-detected cancer, by age group.
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