Five year mortality in an RCT of a lung cancer biomarker to select people for low dose CT screening.

Summary

In a pragmatic RCT of 12,208 high-risk adults, biomarker-guided selection (EarlyCDT-Lung) for LDCT screening was associated with reduced lung cancer mortality at 5 years (adjusted HR 0.789), with stronger benefits among cancers diagnosed within two years of randomization.

Key Findings

• Biomarker-guided arm had fewer lung cancer deaths at 5 years (adjusted HR 0.789; 95% CI 0.636–0.978).
• Among cancers diagnosed within 2 years, all-cause mortality HR 0.615 and lung cancer mortality HR 0.598 favored biomarker-guided selection.
• Randomized 12,208 high-risk adults; outcomes ascertained via death and cancer registries in a pragmatic design.

Clinical Implications

Health systems could integrate blood-based autoantibody testing to triage LDCT eligibility, potentially improving screening efficiency and reducing mortality in high-risk populations.

Limitations

• Open-label screening strategy; potential differences in downstream management
• Generalizability and cost-effectiveness in diverse healthcare systems require evaluation

Future Directions

Head-to-head comparisons with risk models, integration with polygenic and clinical risk, and cost-effectiveness and implementation studies in varied health systems.