Yves Lacasse, MD, MSc, FRCPC
In older patients, does screening with chest radiography reduce lung cancer mortality?
Randomized controlled trial (Prostate, Lung, Colorectal, and Ovarian [PLCO] Cancer Screening Trial). ClinicalTrials.gov NCT00002540.
Unclear allocation concealment.*
Blinded* (cause of death adjudicators).
Up to 13 years (mean 11.2 y). In October 2010, the data safety monitoring board recommended reporting endpoint results because they deemed additional follow-up to be unnecessary.
10 screening centers in the USA.
154 901 adults 55 to 74 years of age (50% women; 45% never-smokers, 10% current smokers). Exclusion criteria included history of prostate, lung, colorectal, or ovarian cancer; current cancer treatment; and removal of 1 lung.
Posterior–anterior chest radiography at baseline and then annually for 3 years (n = 77 445) or usual care (n = 77 456). Some never-smokers in the intervention group were not offered the year 3 screen; patients with positive results on a chest radiograph (a nodule, mass, infiltrate, or other abnormality suspicious for cancer) were advised to seek diagnostic evaluation.
Lung cancer mortality. Secondary outcomes included lung cancer incidence; mortality from causes other than prostate, lung, colorectal, or ovarian cancer; and complications from diagnostic procedures related to screening. Mortality was detected by active follow-up and linkage to the National Death Index. The trial would have had 90% power to detect a 10% reduction in lung cancer mortality with 3796 lung cancer deaths.
99% (intention-to-screen analysis).
Adherence to screening was 87% at baseline and 79% by year 3 in the screening group; 11% (estimated) of the usual care group received screening. There were 2443 lung cancer deaths. Groups did not differ for lung cancer mortality, lung cancer incidence, or mortality due to other causes (Table). 0.4% of patients in the screening group had a complication of a diagnostic procedure; the most common complications were pneumothorax (29%), atelectasis (15%), and infection (10%).
Screening with chest radiography did not reduce mortality in older patients.
†Abbreviations defined in Glossary. RRR, RRI, NNT, NNH, and CI calculated from control event rates and relative risks in article.
‡Excluding deaths from prostate, lung, colorectal, and ovarian cancers.
Lacasse Y. Screening with chest radiography did not reduce lung cancer mortality in older patients. Ann Intern Med. 2012;156:JC3–8. doi: 10.7326/0003-4819-156-6-201202210-02008
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Published: Ann Intern Med. 2012;156(6):JC3-8.
Geriatric Medicine, Hematology/Oncology, Lung Cancer, Pulmonary/Critical Care.
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