A randomized study of lung cancer screening with spiral computed tomography: three-year results from the DANTE trial.
BACKGROUND
Screening for lung cancer with modern imaging technology may decrease lung cancer mortality, but encouraging results have only been obtained in uncontrolled studies.


OBJECTIVE
To explore the effect of screening with low-dose spiral computed tomography (LDCT) on lung cancer mortality. Secondary endpoints are incidence, stage at diagnosis, and resectability.


METHODS
Male subjects, aged 60 to 75 years, smokers of 20 or more pack-years, were randomized to screening with LDCT or control groups. All participants underwent a baseline, once-only chest X-ray and sputum cytology examination. Screening-arm subjects had LDCT upon accrual to be repeated every year for 4 years, whereas controls had a yearly medical examination only.


RESULTS
A total of 2,811 subjects were randomized and 2,472 were enrolled (LDCT, 1,276; control, 1,196). After a median follow-up of 33 months, lung cancer was detected in 60 (4.7%) patients receiving LDCT and 34 (2.8%) control subjects (P = 0.016). Resectability rates were similar in both groups. More patients with stage I disease were detected by LDCT (54 vs. 34%; P = 0.06) and fewer cases were detected in the screening arm due to intercurrent symptoms. However, the number of advanced lung cancer cases was the same as in the control arm. Twenty patients in the LDCT group (1.6%) and 20 controls (1.7%) died of lung cancer, whereas 26 and 25 died of other causes, respectively.


CONCLUSIONS
The mortality benefit from lung cancer screening by LDCT might be far smaller than anticipated.
Infante
Maurizio
M
Thoracic Surgery Department, Istituto Clinico Humanitas, Milan, Italy. maurizio.infante@humanitas.it
Cavuto
Silvio
S
Lutman
Fabio Romano
FR
Brambilla
Giorgio
G
Chiesa
Giuseppe
G
Ceresoli
Giovanni
G
Passera
Eliseo
E
Angeli
Enzo
E
Chiarenza
Maurizio
M
Aranzulla
Giuseppe
G
Cariboni
Umberto
U
Errico
Valentina
V
Inzirillo
Francesco
F
Bottoni
Edoardo
E
Voulaz
Emanuele
E
Alloisio
Marco
M
Destro
Anna
A
Roncalli
Massimo
M
Santoro
Armando
A
Ravasi
Gianluigi
G
D000368:Aged; D002423:Cause of Death; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D013902:Radiography, Thoracic; D015996:Survival Rate; D036542:Tomography, Spiral Computed