The National Lung Screening Trial Premise of Null and Chest Radiography Equivalence Is Open to Question.

Abstract

Lung cancer screening guidelines are based on the National Lung Screening Trial (NLST) that used chest radiographic control subjects on the premise of the reported mortality equivalence in chest radiography versus unscreened persons in the NLST-eligible subgroup of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. The purpose of this article is to discuss concerns regarding the validity of the NLST premise of chest radiography and null screening equivalence. Anomalous findings combined with the failure of CT trials using unscreened control subjects to replicate the benefits of the NLST open to question the validity of this premise.