Are the findings of the National Lung Screening Trial (NLST) of patients at high risk of lung cancer generalizable to the elderly with stage 1 cancer? The trial found that screening using low-dose computed tomography reduced lung cancer mortality by 20 percent. However, the authors point out that trial participants were younger, better educated, less ethnically diverse, and less likely to be active smokers, but more likely to have been treated at a tertiary medical center, than the average elderly person.

In their Sept. 1 American Journal of Respiratory and Critical Care Medicine article, Nichole T. Tanner and colleagues report that surgical mortality and five-year lung cancer survival between a large, representative group of elderly patients with minimal comorbidities was similar to those enrolled in the NLST.

In the current study, however, elderly patients with significant comorbidities had worse 30-, 60-, and 90-day surgical mortality and worse five-year survivorship. These patients were ineligible for NSLT, and the authors write that because of the competing causes of death, there is little value to screening this population. The authors report that among both groups of patients, those whose cancer was treated by non-surgical approaches fared poorly.

The article is titled, "Assessing the Generalizability of the National Lung Screening Trial: Comparison of Patients with Stage 1 Disease."