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Randomized Controlled Trial
. 2009 Nov 1;115(21):5007-17.
doi: 10.1002/cncr.24545.

Randomized controlled trials of the efficacy of lung cancer screening by sputum cytology revisited: a combined mortality analysis from the Johns Hopkins Lung Project and the Memorial Sloan-Kettering Lung Study

V Paul Doria-Rose  1 , Pamela M Marcus, Eva Szabo, Melvyn S Tockman, Myron R Melamed, Philip C Prorok
Affiliations
Randomized Controlled Trial

Randomized controlled trials of the efficacy of lung cancer screening by sputum cytology revisited: a combined mortality analysis from the Johns Hopkins Lung Project and the Memorial Sloan-Kettering Lung Study

V Paul Doria-Rose et al. Cancer. .

Abstract

Background: : Two randomized controlled trials of lung cancer screening initiated in the 1970s, the Johns Hopkins Lung Project and the Memorial Sloan-Kettering Lung Study, compared 1 arm that received annual chest X-ray and 4-monthly sputum cytology (dual-screen) to a second arm that received annual chest X-ray only. Previous publications from these trials reported similar lung cancer mortality between the 2 groups. However, these findings were based on incomplete follow-up, and each trial on its own was underpowered to detect a modest mortality benefit.

Methods: : The authors estimated the efficacy of lung cancer screening with sputum cytology in an intention-to-screen analysis of lung cancer mortality, using combined data from these trials (n = 20,426).

Results: : Over (1/2) of squamous cell lung cancers diagnosed in the dual-screen group were identified by cytology; these cancers tended to be more localized than squamous cancers diagnosed in the X-ray only arm. After 9 years of follow-up, lung cancer mortality was slightly lower in the dual-screen than in the X-ray only arm (rate ratio [RR], 0.88; 95% confidence interval [CI], 0.74-1.05). Reductions were seen for squamous cell cancer deaths (RR, 0.79; 95% CI, 0.54-1.14) and in the heaviest smokers (RR, 0.81; 95% CI, 0.67-1.00). There were also fewer deaths from large cell carcinoma in the dual-screen group, although the reason for this is unclear.

Conclusions: : These data are suggestive of a modest benefit of sputum cytology screening, although we cannot rule out chance as an explanation for these findings. Cancer 2009. (c) 2009 American Cancer Society.

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Figures

Figure 1
Figure 1
Participant flow in the Johns Hopkins Lung Project * Includes one fewer subject than in earlier reports, due to an additional exclusion not noted previously † During first five years of screening ‡ Defined as those who were not followed through the time of their expected five-year screening exam
Figure 2
Figure 2
Participant flow in the Memorial Sloan-Kettering Lung Study * Number of subjects who were assessed but found to be ineligible for randomization not available † During first five years of screening ‡ Defined as those who were not followed through the time of their expected five-year screening exam
Figure 3
Figure 3
Nelson-Aalen cumulative hazard plots for the incidence of squamous cell (A) and non-squamous cell (B) lung cancers, by screening arm, Johns Hopkins Lung Project and Memorial Sloan-Kettering Lung Study data combined
Figure 4
Figure 4
Nelson-Aalen cumulative hazard plots for mortality from squamous cell (A) and non-squamous cell (B) lung cancers, by screening arm, Johns Hopkins Lung Project and Memorial Sloan-Kettering Lung Study data combined
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