***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The UK Lung Screen ( UKLS ) is a r and omised controlled trial of the use of low-dose multidetector CT for lung cancer screening . It completed the Health Technology Appraisal (HTA)-funded feasibility stage in October 2009 and the pilot UKLS will be initiated in early 2011 . The pilot will r and omise 4000 subjects to either low-dose CT screening or no screening . The full study , due to start in September 2012 , if progression criteria are met , will r and omise a further 28 000 subjects from seven centres in the UK . Subjects will be selected if they have sufficient risk of developing lung cancer according to the Liverpool Lung Project risk model . The UKLS employs the ‘ Wald Single Screen Design ’ , which was modelled in the UKLS feasibility study . This paper describes the modelling of nodule management in UKLS by using volumetric analysis with a single initial screen design and follow-up period of 10 years . This modelling has result ed in the development and adoption of the UKLS care pathway , which will be implemented in the planned CT screening trial in the UK OBJECTIVES The aim of this study was to derivate and vali date a prediction model for cardiovascular events based on quantification of coronary and aortic calcium volume in lung cancer screening chest computed tomography ( CT ) . BACKGROUND CT-based lung cancer screening in heavy smokers is a very timely topic . Given that the heavily smoking screening population is also at risk for cardiovascular disease , CT-based screening may provide the opportunity to additionally identify participants at high cardiovascular risk . METHODS Inspiratory screening CT of the chest was obtained in 3,648 screening participants . Next , smoking characteristics , patient demographics , and physician-diagnosed cardiovascular events were collected from 10 years before the screening CT ( i.e. , cardiovascular history ) until 3 years after the screening CT ( i.e. , follow-up time ) . Cox proportional hazards analysis was used to derivate and vali date a prediction model for cardiovascular risk . Age , smoking status , smoking history , and cardiovascular history , together with automatically quantified coronary and aortic calcium volume from the screening CT , were included as independent predictors . The primary outcome measure was the discriminatory value of the model . RESULTS Incident cardiovascular events occurred in 145 of 1,834 males ( derivation cohort ) and 118 of 1,725 males and 2 of 89 females ( validation cohort ) . The model showed good discrimination in the validation cohort with a C-statistic of 0.71 ( 95 % confidence interval : 0.67 to 0.76 ) . When high risk was defined as a 3-year risk of 6 % and higher , 589 of 1,725 males were regarded as high risk and 72 of 118 of all events were correctly predicted by the model . CONCLUSIONS Quantification of coronary and aortic calcium volumes in lung cancer screening CT images-information that is readily available-can be used to predict cardiovascular risk . Such an approach might prove useful in the reduction of cardiovascular morbidity and mortality and may enhance the cost-effectiveness of CT-based screening in heavy smokers In the present study , we performed a prospect i ve follow-up study in a population which underwent chest computed tomography ( CT ) screening .  A total of 6 120 participants underwent a chest CT medical examination for lung cancer and tuberculosis in Nagano Prefecture , Japan , between 1996 and 1997 .  Computed tomography scanning was performed from the apex of the lung to the diaphragm at a tube voltage of 120 kV and a tube current of 50 mA. We measured the CT density of the coronary arteries in 5–7 slices where coronary arteries were detected . The CT density threshold for determining coronary artery calcification ( CAC ) was above + 110 HU . In 2000 , we investigated the number of deaths due to cardiac and noncardiac disease among the participants . Of the 6120 participants , 14  died  of cardiac disease  ( 9 , myocardial infa rct ion ; 4 , heart failure ; and 1 , angina pectoris ) and 64 died of other diseases . Coronary artery calcification was detected in 10 of the patients who died of cardiac disease , and in 31 of those who died of other diseases . The prevalence of CAC was higher in the former than in the latter ( 71.4 % vs 48.4 % , P = 0.084 ) . The relative risk of CAC for cardiac death was 2.66 ( 95 % confidence interval : 0.76 , 9.37 ) . The findings of this study suggested that CAC detected in a mass chest CT screening by a mobile helical CT unit was predictive of future cardiovascular death The Prostate , Lung , Colorectal and Ovarian ( PLCO ) Cancer Screening Trial is enrolling 148,000 men and women ages 55 - 74 at ten screening centers nationwide with balanced r and omization to intervention and control arms . For prostate cancer , men receive a digital rectal examination and a blood test for prostate-specific antigen . For lung cancer , men and women receive a posteroanterior view chest X-ray . For colorectal cancer , men and women undergo a 60-cm flexible sigmoidoscopy . For ovarian cancer , women receive a blood test for the CA125 tumor marker and transvaginal ultrasound . Members of the control arm continue with their usual care . Follow-up in both groups will continue for at least 13 years from r and omization to assess health status and cause of death . The primary endpoint is mortality from the four PLCO cancers , which accounts for about 53 % of all cancer deaths in men and 41 % of cancer deaths in women in the United States each year . Blood specimens are collected from screened participants , buccal cell DNA from controls , and histology slides from cases ; these are maintained in a biorepository . Participants complete a baseline question naire ( covering health status and risk factors ) and a dietary question naire . More than 12,000 participants were enrolled in the pilot phase ( concluded in September 1994 ) . Changes in the eligibility criteria followed . As of April 2000 , enrollment exceeded 144,500 . Data are scanned into design ated on-site computers for uploading by participant identification number to the coordinating center for quality checks , archival storage , and preparation of analysis data sets for use by the National Cancer Institute ( NCI ) . Scientific direction is provided by NCI scientists , trial investigators , external consultants , and an independent data safety and monitoring board . Performance and data quality are monitored via data edits , site visits , r and om record audits , and teleconferences . The PLCO trial is formally endorsed by the American Cancer Society and has been ranked by the American Urological Association as one of the most important prostate cancer studies being conducted . Special efforts to enroll black participants are cosponsored by the U.S. Centers for Disease Control and Prevention BACKGROUND Results of r and omized clinical trials ( RCTs ) are needed to assess the efficacy of lung cancer screening with low-dose chest computed tomography ( CT ) in reducing lung cancer mortality . We report design and results of enrolment and baseline screening test in the ITALUNG trial , a RCT . METHODS Invitation letters were sent to subjects of 55 - 69 years of age clients of 269 general practitioners . Smokers or former smokers of at least 20 pack/years were eligible and after written consent were r and omized in an active arm undergoing a low-dose CT annually for 4 years and in a control arm receiving no screening . Management of positive screening test was carried out using follow-up low-dose CT , fluorodeoxyglucose positron emission tomography , fine needle aspiration cytology and fiber optic bronchoscopy . RESULTS A sample of 3206 eligible subjects was achieved by sending 71,232 letters ( enrolment efficacy = 4.5 % ) . Subjects in control ( n = 1593 ) and active ( n = 1613 ) arm were balanced for age , gender and smoking history . Two-hundred and seven ( 12.8 % ) subjects did not undergo CT after r and omization . The baseline screening test was positive in 426 ( 30.3 % ) of 1406 subjects . Twenty-one lung cancers ( prevalence = 1.5 % ) were found in 20 subjects : 18 non-small cell lung cancer ( NSCLC ) , 2 small cell lung cancer ( SCLC ) and a case of typical carcinoid . Ten NSCLC ( 47.6 % ) were in Stage I. Sixteen fine needle aspirations were performed in 15 lung cancers , with a positive result in 12 ( 75 % ) cases . One biopsy only ( 6.3 % ) was performed on a benign lesion . Seventeen lung cancers ( 81 % ) were treated with surgical resection in 16 subjects . One subject underwent surgery for a benign lesion ( 5.5 % of all surgical resections ) . CONCLUSIONS Recruitment by mail of high risk subjects for a lung cancer screening RCT is feasible but not efficient . Results of the baseline screening test in the active arm of the ITALUNG trial are substantially in line with those of RCT and observational studies BACKGROUND Low-dose spiral CT of the chest effectively detects early-stage  lung cancer in high-risk individuals . The high rate of benign nodules and issues of making a differential diagnosis are critical factors that currently hamper introduction of large-scale screening programmes . We investigated the efficacy of repeated yearly spiral CT and selective use of positron emission tomography ( PET ) in a large cohort of high-risk volunteers . METHODS We enrolled 1035 individuals aged 50 years or older who had smoked for 20 pack-years or more . All patients underwent annual low-dose CT , with or without PET , for 5 years . Lesions up to 5 mm were deemed non-suspicious and low-dose CT was repeated after 12 months ( year 2 ) . FINDINGS By year 2 , 22 cases of lung cancer had been diagnosed ( 11 at baseline , 11 at year 2 ) . 440 lung lesions were identified in 298 ( 29 % ) participants , and 95 were recalled for high-resolution contrast CT . PET scans were positive in 18 of 20 of the identified cancer cases . Six patients underwent surgical biopsy for benign disease because of false-positive results ( 6 % of recalls , 22 % of invasive procedures ) . Complete resection was achieved in 21 ( 95 % ) lung cancers , 17 ( 77 % ) were pathological stage I ( 100 % at year 2 ) , and the mean tumour size was 18 mm . There were no interval lung cancers in the 2.5 years of follow-up ( average time on study from r and omisation to last contact ) , although 19 individuals were diagnosed with another form of cancer ( two deaths and 17 non-fatal admissions ) . INTERPRETATION Combined use of low-dose spiral CT and selective PET effectively detects early lung cancer . Lesions up to 5 mm can be checked again at 12 months without major risks of progression BACKGROUND Lung cancer has the highest mortality-rate per cancer , with an overall 5-year survival < 15 % . Several non-r and omized studies pointed out the high sensitivity of low dose computed tomography ( LDCT ) to detect early stage lung cancer . In France , Depiscan , a pilot RCT of LDCT versus chest X-ray ( CXR ) , started on October 2002 to determine the feasibility of enrollment by general practitioners ( GPs ) , investigations and diagnostic procedures by university hospital radiologists and multidisciplinary teams , data management by central ized clinical research assistants , and anticipate the future management of a large national trial . METHODS GPs and occupational physicians ( OPs ) selected and enrolled 1000 subjects in 1 year . Eligible subjects were asymptomatic males or females aged 50 - 75 years with a current or former cigarette smoking history of > /=15 cigarettes per day for at least 20 years ( former smokers having quit < 15 years prior to enrollment ) . Based to r and omization , annual LDCT or CXR screenings were planned at baseline and annually for 2 years . RESULTS Between October 2002 and December 2004 , 765 subjects were enrolled by 89 out of the 232 participating GPs and OPs . Complete clinical and imaging baseline data were available for 621 individuals out of the 765 enrolled , due to 144 noncompliant subjects who withdrew their consent . At least one nodule was detected in 152 out of 336 subjects ( 45.2 % ) in the LDCT screening , versus 21 out of 285 subjects ( 7.4 % ) in the CXR screening arm . Eight lung cancers were detected in the LDCT arm and one in the CXR arm . DISCUSSION This pilot trial allows estimating that non-calcified nodules are 10 [ 6.36 - 17.07 ] times more often detected from LDCT than from CXR . However enrollment by GPs was more difficult than expected with 41 % active investigators and a high rate ( 19 % ) of noncompliant patients . This experience speaks to the need for a high level of GPs formation and a large , coordinated clinical research team in such a trial . TRIAL REGISTRATION 
    Output:
    
Assessment of non-electrocardiogram-gated CAC in lung cancer screening programs is a robust prognostic measure of fatal or non-fatal cardiovascular events in current and former smokers independent of traditional cardiovascular risk factors