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

• Published in: Cancer Vol. 115; no. 21; pp. 5007 - 5017
• Main Authors: Doria-Rose, V Paul, Marcus, Pamela M, Szabo, Eva, Tockman, Melvyn S, Melamed, Myron R, Prorok, Philip C
• Format: Journal Article
• Language: English
• Published: United States 01-11-2009
• Subjects: Aged; Cytodiagnosis - methods; Early Detection of Cancer; Humans; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Male; Middle Aged; Radiography; Sputum - cytology
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.24545

: 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.
: 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).
: 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.
: 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.