The NELSON study is a population-based, randomized controlled lung cancer screening trial conducted in the Netherlands and Belgium. It includes a follow-up period of 10 years after the first screening round. The study enrolled 15,792 individuals aged 50–75 years with a smoking history of more than 15 cigarettes per day for over 25 years or more than 10 cigarettes per day for at least 30 years. Former smokers were eligible if they had quit smoking within the past 10 years. Participants were randomized in a 1:1 ratio into screening and control groups. Those assigned to the screening group were invited to undergo low-dose CT chest scans at intervals of 1, 2, and 2.5 years.

The NELSON-POP project extends the multicenter NELSON trial with new data. New data will be added on air pollution, genetics, CT markers of emphysema, coronary calcification, osteopenia and body composition, and malignancy risk for lung nodules. The relation of air pollution measures and polygenic risk scores to lung cancer and survival will be studied. The association of chest CT imaging biomarkers with outcomes will be established. At baseline and incident screening rounds, AI-based nodule malignancy score will be related to lung cancer diagnosis. Based on these results, we will develop multi-source prediction models for screenee selection, before selection for screening, and after first CT screening, and for nodule management (Figure 1). 

The NELSON trial was approved by the Dutch Minister of Health and the medical ethics committee at each participating site.  Funding for NELSON POP is provided by a Public Private Partnership grant, from the Dutch Cancer Foundation, Siemens Healthineers and Health Holland.