The Stockholm Pilot study for Lung cancer Screening (Stockholm PLUS): feasibility of baseline low-dose CT lung cancer screening in a high-risk Swedish female population

BACKGROUND AND PURPOSE: Low-dose CT screening of high-risk groups has been shown to reduce lung cancer mortality, and the European Council has therefore recommended that member states explore the feasibility and effectiveness of this approach. In this study, we evaluate the implementation of low-dose CT screening for lung cancer in a Swedish female population. Patient/material and methods: Women aged 54-74 years in the Southern Stockholm region were contacted via an electronic questionnaire. Individuals who met the same eligibility criteria as in the NELSON trial (a minimum smoking history of 15 pack-years) were invited. The screening consisted of a baseline low-dose computed tomography (LDCT) scan, with the option for a follow-up scan in cases with intermediate findings. Findings were managed in accordance with modified Fleischner Society guidelines. RESULTS: Between September 2022 and September 2024, 34,580 invitation letters were sent to randomly selected women aged 54-74 years 11,607 individuals (33.4%) completed the questionnaire, whereof 1,106 (10%) met the inclusion criteria. 990 (90%) individuals accepted the invitation and underwent a baseline low-dose CT scan. There were 152 intermediate and 55 positive scans at baseline, and additional eight positive scans at follow-up. Fifteen cases of Lung cancer were found, yielding a positive prediction value (PPV) of 24%. 87% of the lung cancers were in stage IA. INTERPRETATION: Organized lung cancer screening in a Swedish female population proved feasible, demonstrating a good participation rate, and a cancer detection rate consistent with findings from other major screening trials.