Andrea Bezjak, MDCM, MSc
In older men with a history of smoking, does screening with spiral computed tomography (CT) decrease lung cancer mortality?
Randomized controlled trial (RCT) (Detection and Screening of Early Lung Cancer by Novel Imaging Technology and Molecular Essays [DANTE] trial). ClinicalTrials.gov NCT00420862.
Median 33.7 months.
3 hospitals in Italy.
2811 men 60 to 74 years of age with a history of ≥ 20 pack-years of smoking. Exclusion criteria included malignancy within the previous 10 years (except early laryngeal and nonmelanoma skin cancer if disease-free ≥ 5 y) and life expectancy < 5 years. 2472 men (mean age 64 y) met inclusion criteria and were enrolled.
All patients had baseline chest radiographs and 3-day sputum cytology testing and annual medical interviews and physical examinations. Patients in the low-dose spiral computed tomography (LDCT) screening group (n = 1276) had CT scans of the chest at baseline and annually for 4 years. Patients in the control group (n = 1196) had no additional imaging or tests unless clinical abnormalities were detected.
Primary outcome was lung cancer mortality. Secondary outcomes included incidence of lung cancer, stage at diagnosis, resectability, and all-cause mortality. The study had 80% power to detect a 35% reduction in lung cancer mortality (α = 0.05).
Detection rates for overall and stage I lung cancer were higher in the LDCT screening group than in the control group (Table). LDCT and control groups did not differ for detection of stage IIIB to IV cancer (1.3% vs 1.4%, P = 0.86), complete resectability of detected tumors (60% vs 50%, P = 0.35), or overall or lung cancer mortality (Table). Invasive procedures were performed more often in the LDCT group (7.5% vs 3%, P < 0.001).
Screening with low-dose spiral computed tomography detected more cases of stage I lung cancer but did not reduce mortality in older men who smoked.
Screening with low-dose spiral computed tomography (LDCT) vs control for reducing mortality in men with a smoking history‡
‡Abbreviations defined in Glossary; RRR, RBI, NNT, and CI calculated from data in article.
Bezjak A. Screening with spiral CT did not reduce lung cancer mortality in older male smokers. Ann Intern Med. ;151:JC6–11. doi: 10.7326/0003-4819-151-12-200912150-02011
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Published: Ann Intern Med. 2009;151(12):JC6-11.
Cardiology, Coronary Risk Factors, Hematology/Oncology, Lung Cancer, Pulmonary/Critical Care.
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