Modeling of long-term screening for lung carcinoma

Abstract

Background: Results from the Mayo Lung Project (MLP), a randomized clinical trial for the early detection of lung carcinoma, were interpreted as proof that the early detection of lung carcinoma by chest X-ray does not reduce the mortality from this disease. Recent analysis of extended follow-up data from the MLP subjects found that after approximately 20 years there still was no apparent difference in lung carcinoma mortality between a study group and a control group.

Methods: To view this result within context, the authors utilized a previously published simulation model of the MLP, with parametric values that were estimated at the time of the original publication based on the data collected by the MLP.

Results: The model produced predictions of the extended follow-up statistics that were found to be consistent with the data published in the prior study. The authors believe this provides long-term validation for the model. Conversely, the same model demonstrated that had the study subjects been screened annually for the extended follow-up period, the difference in mortality would be noticeable, even with the low sensitivity of chest X-ray detection.

Conclusions: The results of current study strongly suggest that long-term screening with chest X-ray results in a reduction in lung carcinoma mortality. The limited extent of this benefit is the result of the low sensitivity of chest X-ray as a screening tool.