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  1. Whyshouldwewanttoscreen? Survival (years) Goldstraw et al. J ThoracOncol 2007

  2. Whyshouldwewanttoscreen? Localised Stage shift ! Regional spread Distantspread Whendiagnosisisbased on symptoms Whendiagnosisisbased on screening

  3. National lungscreeningtrial (NLST) • Inclusioncriteria • Age 55-74 years • Smoking history ≥30PY, activeorstoppedlessthan 15 yearsago • Exclusioncriteria • History of lungcancer • Other priorcancer in past 5 years • Chest CT lessthan 18 monthsago • Unexplainedweightloss (>15lb in pastyear) • Metallic implantsordevices in chestor back • Home oxygensupplementation • Pneumoniatreatedwithantibiotics in past 12 weeks Aberle et al. N Engl J Med 2011

  4. National lungscreeningtrial (NLST) • 53’454 subjectsrandomisedtoone of twogroups: • Low dose CT • Chest X-ray • 3 screening roundsatannualintervals • Non-calcifiednodules ≥4mm in CT oranysize in X-raywerereferredfordiagnosticwork-up • Primary outcome: lungcancerrelatedmortality Aberle et al. N Engl J Med 2011

  5. National lungscreeningtrial (NLST) Aberle et al. N Engl J Med 2011

  6. National lungscreeningtrial (NLST) Aberle et al. N Engl J Med 2011

  7. National lungscreeningtrial (NLST) Kovalchik et al. N Engl J Med 2013

  8. National lungscreeningtrial (NLST) Kovalchik et al. N Engl J Med 2013

  9. Lung cancer screening trials Boiselle, JAMA 2013

  10. Screening recommendations Boiselle, JAMA 2013

  11. Open issues • Isone positive trialenoughevidence? • Was thereoverdiagnosis in the NSLT? • Will otherpopulationsatriskoflungcancerbenefitfrom CT screening? • Screening of a large, at-riskpopulationpossible? • Howmanyscreeningrounds? • Costeffectiveness? • «sideeffects» ofscreening (i.e.radiationexposure)

  12. Conclusions • Lung cancer is a lethal disease associated with substantial medical and economic burden. • NLST: lung cancer screening may reduce mortality considerably. • Possible advantage of LDCT screening has to be balanced against the potential of inducing harm. • Many issues are not yet resolved: i.e. overdiagnosis, number of screening rounds, study population, cost-efficacy. • Further evidenceandinformationisneeded, beforelungcancerscreeningcanberecommended in Switzerland.