***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: BACKGROUND Lung cancer screening might be a teachable moment for smoking cessation intervention . The objective was to investigate whether a tailored self-help smoking cessation intervention is more effective in inducing smoking cessation compared to a st and ard brochure in male smokers who participate in the Dutch-Belgian r and omised controlled lung cancer screening trial ( NELSON trial ) . METHODS Two r and om sample s of male smokers who had received either a st and ard brochure ( n=642 ) or a tailoring question naire for computer-tailored smoking cessation information ( n=642 ) were sent a question naire to measure smoking behaviour two years after r and omisation . RESULTS Twenty-three percent of the male smokers in the tailored information group returned a completed tailoring question naire and thus received the tailored advice . The prolonged smoking abstinence was slightly , but not statistically significant , lower amongst those r and omised in the tailored information group ( 12.5 % ) compared with the brochure group ( 15.6 % ) ( OR=0.77 ( 95%-CI : 0.56 - 1.06 ) . The level of education and intention to quit smoking significantly predicted smoking cessation at follow-up ( p<0.05 ) . The majority of the respondents did not recall whether and which smoking cessation intervention they had received at r and omisation after 2-years of follow-up . CONCLUSION The current study showed no advantage of tailored smoking cessation information over st and ard self-help information amongst male smokers with a long term smoking history who participate in a lung cancer screening trial after two years of follow-up . However , the low percentage participants who actually received the tailored advice limited the ability to find an advantage BACKGROUND Low-dose CT screening is recommended for individuals at high risk of developing lung cancer . However , CT screening does not detect all lung cancers : some might be missed at screening , and others can develop in the interval between screens . The NELSON trial is a r and omised trial to assess the effect of screening with increasing screening intervals on lung cancer mortality . In this prespecified analysis , we aim ed to assess screening test performance , and the epidemiological , radiological , and clinical characteristics of interval cancers in NELSON trial participants assigned to the screening group . METHODS Eligible participants in the NELSON trial were those aged 50 - 75 years , who had smoked 15 or more cigarettes per day for more than 25 years or ten or more cigarettes for more than 30 years , and were still smoking or had quit less than 10 years ago . We included all participants assigned to the screening group who had attended at least one round of screening . Screening test results were based on volumetry using a two-step approach . Initially , screening test results were classified as negative , indeterminate , or positive based on nodule presence and volume . Subsequently , participants with an initial indeterminate result underwent follow-up screening to classify their final screening test result as negative or positive , based on nodule volume doubling time . We obtained information about all lung cancer diagnoses made during the first three rounds of screening , plus an additional 2 years of follow-up from the national cancer registry . We determined epidemiological , radiological , participant , and tumour characteristics by reassessing medical files , screening CTs , and clinical CTs . The NELSON trial is registered at www.trialregister.nl , number IS RCT N63545820 . FINDINGS 15,822 participants were enrolled in the NELSON trial , of whom 7915 were assigned to low-dose CT screening  with increasing interval between screens , and 7907 to no screening .  We included 7155 participants in our study , with median follow-up of 8·16 years ( IQR 7·56 - 8·56 ) . 187 ( 3 % ) of 7155 screened participants were diagnosed with 196 screen-detected lung cancers , and another 34 ( < 1 % ; 19 [ 56 % ] in the first year after screening , and 15 [ 44 % ] in the second year after screening ) were diagnosed with 35 interval cancers . For the three screening rounds combined , with a 2-year follow-up , sensitivity was 84·6 % ( 95 % CI 79·6 - 89·2 ) , specificity was 98·6 % ( 95 % CI 98·5 - 98·8 ) , positive predictive value was 40·4 % ( 95 % CI 35·9 - 44·7 ) , and negative predictive value was 99·8 % ( 95 % CI 99·8 - 99·9 ) . Retrospective assessment of the last screening CT and clinical CT in 34 patients with interval cancer showed that interval cancers were not visible in 12 ( 35 % ) cases . In the remaining cases , cancers were visible when retrospectively assessed , but were not diagnosed because of radiological detection and interpretation errors ( 17 [ 50 % ] ) , misclassification by the protocol ( two [ 6 % ] ) , participant non-compliance ( two [ 6 % ] ) , and non-adherence to protocol ( one [ 3 % ] ) . Compared with screen-detected cancers , interval cancers were diagnosed at more advanced stages ( 29 [ 83 % ] of 35 interval cancers vs 44 [ 22 % ] of 196 screen-detected cancers diagnosed in stage III or IV ; p<0·0001 ) , were more often small-cell carcinomas ( seven [ 20 % ] vs eight [ 4 % ] ; p=0·003 ) and less often adenocarcinomas ( nine [ 26 % ] vs 102 [ 52 % ] ; p=0·005 ) . INTERPRETATION Lung cancer screening in the NELSON trial yielded high specificity and sensitivity , with only a small number of interval cancers . The results of this study could be used to improve screening algorithms , and reduce the number of missed cancers . FUNDING Zorgonderzoek Nederl and Medische Wetenschappen and Koningin Wilhelmina Fonds The National Lung Screening Trial ( NLST ) has sparked new interest in the adoption of lung cancer screening using low-dose computed tomography ( LDCT ) . If adopted at a national level , LDCT screening may prevent approximately 18,000 lung cancer deaths per year , potentially constituting a high-value public health intervention . Before incorporating LDCT screening into practice , health care institutions need to consider the risks associated with LDCT screening and the impact of LDCT screening on health care costs , as well as other remaining areas of uncertainty , including the unknown cost-effectiveness of LDCT screening . This article will review the benefits and risks of LDCT screening in light of the results of the NLST and other r and omized trials , it will discuss the additional health care costs associated with LDCT screening from the perspective of health care payers , and it will examine the published cost-effectiveness analyses of LDCT screening . A subsequent discussion highlights guideline recommendations for implementation strategies , the goals of which are to ensure that those eligible for LDCT screening derive the benefits while minimizing the risks of screening and avoiding an unnecessary escalation in screening-related costs . The article concludes by endorsing the use of LDCT screening in institutions capable of responsible implementation of screening in both medical and economic terms . The key elements of responsible implementation include the development of st and ardized screening practice s , careful selection of screening c and i date s , and the creation of prospect i ve registries that will mitigate current areas of uncertainty regarding LDCT screening BACKGROUND Reliable risk prediction tools for estimating individual probability of lung cancer have important public health implication s. We constructed and vali date d a comprehensive clinical tool for lung cancer risk prediction by smoking status . METHODS Epidemiologic data from 1851 lung cancer patients and 2001 matched control subjects were r and omly divided into separate training ( 75 % of the data ) and validation ( 25 % of the data ) sets for never , former , and current smokers , and multivariable models were constructed from the training sets . The discriminatory ability of the models was assessed in the validation sets by examining the areas under the receiver operating characteristic curves and with concordance statistics . Absolute 1-year risks of lung cancer were computed using national incidence and mortality data . An ordinal risk index was constructed for each smoking status category by summing the odds ratios from the multivariable regression analyses for each risk factor . RESULTS All variables that had a statistically significant association with lung cancer ( environmental tobacco smoke , family history of cancer , dust exposure , prior respiratory disease , and smoking history variables ) have strong biologically plausible etiologic roles in the disease . The concordance statistics in the validation sets for the never , former , and current smoker models were 0.57 , 0.63 , and 0.58 , respectively . The computed 1-year absolute risk of lung cancer for a hypothetical male current smoker with an estimated relative risk close to 9 was 8.68 % . The ordinal risk index performed well in that true-positive rates in the design ated high-risk categories were 69 % and 70 % for current and former smokers , respectively . CONCLUSIONS If confirmed in other studies , this risk assessment procedure could use easily obtained clinical information to identify individuals who may benefit from increased screening surveillance for lung cancer . Although the concordance statistics were modest , they are consistent with those from other risk prediction models Objective To evaluate the impact of telling patients their estimated spirometric lung age as an incentive to quit smoking . Design R and omised controlled trial . Setting Five general practice s in Hertfordshire , Engl and . Participants 561 current smokers aged over 35 . Intervention All participants were offered spirometric assessment of lung function . Participants in intervention group received their results in terms of  “  lung age ” ( the age of the average healthy individual who would perform similar to them on spirometry ) . Those in the control group received a raw figure for forced expiratory volume at one second ( FEV1 ) . Both groups were advised to quit and offered referral to local NHS smoking cessation services . Main outcome measures The primary outcome measure was verified cessation of smoking by salivary cotinine testing 12 months after recruitment . Secondary outcomes were reported changes in daily consumption of cigarettes and identification of new diagnoses of chronic obstructive lung disease . Results Follow-up was 89 % . Independently verified quit rates at 12 months in the intervention and control groups , respectively , were 13.6 % and 6.4 % ( difference 7.2 % , P=0.005 , 95 % confidence interval 2.2 % to 12.1 % ; number needed to treat 14 ) . People with worse spirometric lung age were no more likely to have quit than those with normal lung age in either group . Cost per successful quitter was estimated at £ 280 ( € 366 , $ 556 ) . A new diagnosis of obstructive lung disease was made in 17 % in the intervention group and 14 % in the control group ; a total of 16 % ( 89/561 ) of participants . Conclusion Telling smokers their lung age significantly improves the likelihood of them quitting smoking , but the mechanism by which this intervention achieves its effect is unclear . Trial registration National Research Register N0096173751 BACKGROUND Although there is no proven benefit associated with screening for lung cancer , screening programs are attracting many individuals who perceive themselves to be at high risk due to smoking . We sought to determine whether the risk of lung cancer varies predictably among smokers . METHODS We used data on 18 172 subjects enrolled in the Carotene and Retinol Efficacy Trial (CARET)-a large , r and omized trial of lung cancer prevention-to derive a lung cancer risk prediction model . Model inputs included the subject 's age , sex , asbestos exposure history , and smoking history . We assessed the model 's calibration by comparing predicted and observed rates of lung cancer across risk deciles and vali date d it by assessing the extent to which a model estimated on data from five CARET study sites could predict events in the sixth study site . We then applied the model to evaluate the risk of lung cancer among smokers enrolled in a study of lung cancer screening with computed tomography ( CT ) .  RESULTS The model was internally valid and well calibrated . Ten-year lung cancer risk varied greatly among participants in the CT study , from 15 % for a 68-year-old man who has smoked two packs per day for 50 years and continues to smoke , to 0.8 % for a 51-year-old woman who smoked one pack per day for 28 years before quitting 9 years earlier . Even among the subset of CT study participants who would be eligible for a clinical trial of cancer prevention , risk varied greatly . CONCLUSIONS The risk of lung cancer varies widely among smokers . Accurate risk prediction may help individuals who are contemplating voluntary screening to balance the potential benefits and risks . Risk prediction may also be useful for research ers design ing clinical trials of lung cancer prevention STUDY OBJECTIVES To develop and vali date a model for estimating the risk of lung cancer death  in current and former smokers . The model is intended for use in analyzing a population of subjects who are undergoing lung cancer screening or receiving lung cancer chemoprevention  , to determine whether the intervention has altered lung cancer mortality . DESIGN / SETTING / PATIENTS Model derivation was based on analyses of the placebo arm of the Carotene and Retinol Efficacy Trial . Model validation was based on analyses of three other longitudinal cohorts . MEASUREMENTS Observed and predicted number of deaths due to lung cancer . RESULTS In internal validation , the model was highly concordant and well calibrated . In external validation , the model predictions were similar to what was observed in all of the validation analyses . The predicted and observed deaths within 6 years were very similar when ass 
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CONCLUSIONS Following the strategies delineated in this policy statement may help sites to develop comprehensive LDCT screening programs that are safe and effective