Screening for lung cancer. The Mayo Lung Project revisited.
BACKGROUND
The Mayo Lung Project (MLP) reported lung cancer incidence and mortality in a population offered chest radiographs and sputum cytologic screening examinations every 4 months and a population offered only the Mayo Clinic advice to undergo annual examination. No mortality benefit attributable to screening was observed after 6 years of observation and at least 1 year of follow-up.


METHODS
The authors describe a simulation study designed to estimate from Mayo data the parameters in a mathematical model of the natural history of lung cancer and to estimate the potential benefit associated with periodic screening of high-risk people starting at 45 years of age.


RESULTS
It was found that the mean duration of Stage I non-small cell lung cancer is at least 4 years and that rates of Stage I detectability and curability are less than 25% and 35%, respectively.


CONCLUSIONS
A trial of the magnitude, duration, and contamination of the MLP would have a less than 20% probability of showing significant benefit from screening; however, long-term annual screening might result in a modest decrease in lung cancer mortality, ranging from 0% to 13%. A greater benefit would accrue from improved detection and treatment.
Flehinger
B J
BJ
Mathematical Sciences Department, T. J. Watson Research Center, Yorktown Heights, New York 10598.
Kimmel
M
M
Polyak
T
T
Melamed
M R
MR
D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D002423:Cause of Death; D003198:Computer Simulation; D005500:Follow-Up Studies; D006801:Humans; D008017:Life Expectancy; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D008954:Models, Biological; D009367:Neoplasm Staging; D015995:Prevalence; D011336:Probability; D013902:Radiography, Thoracic; D013183:Sputum / Q000166:cytology; D015996:Survival Rate