title: Long-Term Follow-up Results of the DANTE Trial, a Randomized Study of Lung Cancer Screening with Spiral Computed Tomography.
abstract: BACKGROUND
  Screening for lung cancer with low-dose spiral computed tomography (LDCT) has been shown to reduce lung cancer mortality by 20% compared with screening with chest X-ray (CXR) in the National Lung Screening Trial, but uncertainty remains concerning the efficacy of LDCT screening in a community setting.
  
  
  OBJECTIVE
  To explore the effect of LDCT screening on lung cancer mortality compared with no screening. Secondary endpoints included incidence, stage, and resectability rates.
  
  
  METHODS
  Male smokers of 20+ pack-years, aged 60 to 74 years, underwent a baseline CXR and sputum cytology examination and received five screening rounds with LDCT or a yearly clinical review only in a randomized fashion.
  
  
  RESULTS
  A total of 1,264 subjects were enrolled in the LDCT arm and 1,186 in the control arm. Their median age was 64.0 years (interquartile range, 5), and median smoking exposure was 45.0 pack-years. The median follow-up was 8.35 years. One hundred four patients (8.23%) were diagnosed with lung cancer in the screening arm (66 by CT), 47 of whom (3.71%) had stage I disease; 72 control patients (6.07%) were diagnosed with lung cancer, with 16 (1.35%) being stage I cases. Lung cancer mortality was 543 per 100,000 person-years (95% confidence interval, 413-700) in the LDCT arm versus 544 per 100,000 person-years (95% CI, 410-709) in the control arm (hazard ratio, 0.993; 95% confidence interval, 0.688-1.433).
  
  
  CONCLUSIONS
  Because of its limited statistical power, the results of the DANTE (Detection And screening of early lung cancer with Novel imaging TEchnology) trial do not allow us to make a definitive statement about the efficacy of LDCT screening. However, they underline the importance of obtaining additional data from randomized trials with intervention-free reference arms before the implementation of population screening.
authors.affiliation: 1 Department of Thoracic Surgery.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Infante
authors.forename: Silvio
authors.initials: S
authors.lastname: Cavuto
authors.forename: Fabio Romano
authors.initials: FR
authors.lastname: Lutman
authors.forename: Eliseo
authors.initials: E
authors.lastname: Passera
authors.forename: Maurizio
authors.initials: M
authors.lastname: Chiarenza
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Chiesa
authors.forename: Giorgio
authors.initials: G
authors.lastname: Brambilla
authors.forename: Enzo
authors.initials: E
authors.lastname: Angeli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aranzulla
authors.forename: Arturo
authors.initials: A
authors.lastname: Chiti
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
authors.forename: Pierina
authors.initials: P
authors.lastname: Navarria
authors.forename: Raffaele
authors.initials: R
authors.lastname: Cavina
authors.forename: Michele
authors.initials: M
authors.lastname: Ciccarelli
authors.forename: Massimo
authors.initials: M
authors.lastname: Roncalli
authors.forename: Anna
authors.initials: A
authors.lastname: Destro
authors.forename: Edoardo
authors.initials: E
authors.lastname: Bottoni
authors.forename: Emanuele
authors.initials: E
authors.lastname: Voulaz
authors.forename: Valentina
authors.initials: V
authors.lastname: Errico
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ferraroli
authors.forename: Giovanna
authors.initials: G
authors.lastname: Finocchiaro
authors.forename: Luca
authors.initials: L
authors.lastname: Toschi
authors.forename: Armando
authors.initials: A
authors.lastname: Santoro
authors.forename: Marco
authors.initials: M
authors.lastname: Alloisio
mesh_terms: D000368:Aged; D002423:Cause of Death; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000379:methods* / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D013902:Radiography, Thoracic; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D013183:Sputum / Q000166:cytology*; D036542:Tomography, Spiral Computed / Q000379:methods*
keywords: early diagnosis; lung neoplasms; randomized controlled trial; screening; spiral computed tomography