Evidence map›Paper›PMID 40877276›Full record

Trial reportNature communications2025

A comparative analysis of heterogeneity in lung cancer screening effectiveness in two randomised controlled trials.

Max Welz, Carlijn M van der Aalst, Andreas Alfons, Andrea A Naghi, Marjolein A Heuvelmans, Harry J M Groen, Pim A de Jong, Joachim Aerts, Matthijs Oudkerk, Harry J de Koning and 2 more

Abstract readComparative StudyRandomized Controlled Trial
In one paragraph

Trial report in Nature communications, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Max WelzDepartment of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands. welz@ese.eur.nl.
Carlijn M van der AalstDepartment of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.
Andreas AlfonsEconometric Institute, Erasmus University Rotterdam, Rotterdam, the Netherlands.ORCID http://orcid.org/0000-0002-2513-3788
Andrea A NaghiEconometric Institute, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Marjolein A HeuvelmansUniversity of Groningen. University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands.
Harry J M GroenRijksuniversiteit Groningen, Groningen, the Netherlands.ORCID http://orcid.org/0000-0002-2978-5265
Pim A de JongDepartment of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Joachim AertsDepartment of Pulmonary Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.ORCID http://orcid.org/0000-0001-6662-2951
Matthijs OudkerkInstitute for Diagnostic Accuracy, Groningen, the Netherlands.ORCID http://orcid.org/0000-0003-2800-4110
Harry J de Koning *Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.ORCID http://orcid.org/0000-0003-4682-3646
Kevin Ten Haaf *Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands. k.tenhaaf@erasmusmc.nl.ORCID http://orcid.org/0000-0001-5006-6938
NELSON trial consortium

Funding

ZonMw (Netherlands Organisation for Health Research and Development) 09150161910060
6 · The paper itself

Abstract

Clinical trials demonstrate that screening can reduce lung cancer mortality by over 20%. However, lung cancer screening effectiveness (reduction in lung cancer specific mortality) may vary by personal risk-factors. Here we evaluate heterogeneity in lung cancer screening effectiveness through traditional sub-group analyses, predictive modelling approaches and machine-learning in individual-level data from the Dutch-Belgian lung cancer screening trial (NELSON; 14,808 participants, 12,429 men, 2377 women, 2 persons with an unknown sex) and the National Lung Screening Trial (NLST; 53,405 participants, 31,501 men, 21,904 women). We find that screening effectiveness varies by pack-years (screening effectiveness ranges across trials: lowest groups = 26.8-50.9%, highest groups = 5.5-9.5%), smoking status (screening effectiveness ranges across trials: former smokers = 37.8-39.1%, current smokers = 16.1-22.7%) and sex (screening effectiveness ranges across trials: women = 24.6-25.3%; men = 8.3-24.9%). Furthermore, screening effectiveness varies by histology (screening effectiveness ranges across trials: adenocarcinoma = 17.8-23.0%, other lung cancers = 24.5-35.5%, small-cell carcinoma = 9.7%-11.3%). Screening is ineffective for squamous-cell carcinoma in NLST (screening effectiveness = 27.9% (95% confidence interval: 69.8% increase to 4.5% decrease) mortality increase) but effective in NELSON (screening effectiveness = 52.2% (95% confidence interval: 25.7-69.1% decrease) mortality reduction). We find that variations in screening effectiveness across pack-years, smoking status, and sex are primarily explained by a greater prevalence of histologies with favourable screening effectiveness in these groups. Our study shows that heterogeneity in lung screening effectiveness is primarily driven by histology and that relaxing smoking-related screening eligibility criteria may enhance screening effectiveness.

Indexed as

Early Detection of CancerLung NeoplasmsAgedBelgiumFemaleHumansMachine LearningMaleMass ScreeningMiddle AgedNetherlandsRandomized Controlled Trials as TopicRisk FactorsSmoking

Identifiers

PMID40877276
PMCPMC12394595

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.