Screening by chest radiograph and lung cancer mortality: the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized trial.
BACKGROUND
The effect on mortality of screening for lung cancer with modern chest radiographs is unknown.


OBJECTIVE
To evaluate the effect on mortality of screening for lung cancer using radiographs in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.


METHODS
Randomized controlled trial that involved 154,901 participants aged 55 through 74 years, 77,445 of whom were assigned to annual screenings and 77,456 to usual care at 1 of 10 screening centers across the United States between November 1993 and July 2001. The data from a subset of eligible participants for the National Lung Screening Trial (NLST), which compared chest radiograph with spiral computed tomographic (CT) screening, were analyzed.


METHODS
Participants in the intervention group were offered annual posteroanterior view chest radiograph for 4 years. Diagnostic follow-up of positive screening results was determined by participants and their health care practitioners. Participants in the usual care group were offered no interventions and received their usual medical care. All diagnosed cancers, deaths, and causes of death were ascertained through the earlier of 13 years of follow-up or until December 31, 2009.


METHODS
Mortality from lung cancer. Secondary outcomes included lung cancer incidence, complications associated with diagnostic procedures, and all-cause mortality.


RESULTS
Screening adherence was 86.6% at baseline and 79% to 84% at years 1 through 3; the rate of screening use in the usual care group was 11%. Cumulative lung cancer incidence rates through 13 years of follow-up were 20.1 per 10,000 person-years in the intervention group and 19.2 per 10,000 person-years in the usual care group (rate ratio [RR]; 1.05, 95% CI, 0.98-1.12). A total of 1213 lung cancer deaths were observed in the intervention group compared with 1230 in usual care group through 13 years (mortality RR, 0.99; 95% CI, 0.87-1.22). Stage and histology were similar between the 2 groups. The RR of mortality for the subset of participants eligible for the NLST, over the same 6-year follow-up period, was 0.94 (95% CI, 0.81-1.10).


CONCLUSIONS
Annual screening with chest radiograph did not reduce lung cancer mortality compared with usual care.


BACKGROUND
clinicaltrials.gov Identifier: NCT00002540.
School of Public Health, University of Minnesota, Minneapolis, USA.
Martin M
MM
Oken
Willam G
WG
Hocking
Paul A
PA
Kvale
Gerald L
GL
Andriole
Saundra S
SS
Buys
Timothy R
TR
Church
E David
ED
Crawford
Mona N
MN
Fouad
Claudine
C
Isaacs
Douglas J
DJ
Reding
Joel L
JL
Weissfeld
Lance A
LA
Yokochi
Barbara
B
O'Brien
Lawrence R
LR
Ragard
Joshua M
JM
Rathmell
Thomas L
TL
Riley
Patrick
P
Wright
Neil
N
Caparaso
Ping
P
Hu
Grant
G
Izmirlian
Paul F
PF
Pinsky
Philip C
PC
Prorok
Barnett S
BS
Kramer
Anthony B
AB
Miller
John K
JK
Gohagan
Christine D
CD
Berg
D000368:Aged; D002423:Cause of Death; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D013902:Radiography, Thoracic; D014481:United States / Q000453:epidemiology