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Abstract
Rationale: Screening for lung cancer with low-dose spiral computed tomography (LDCT) has been shown to reduce lung cancer mortality by 20% compared with screening with chest X-ray (CXR) in the National Lung Screening Trial, but uncertainty remains concerning the efficacy of LDCT screening in a community setting.
Objectives: To explore the effect of LDCT screening on lung cancer mortality compared with no screening. Secondary endpoints included incidence, stage, and resectability rates.
Methods: Male smokers of 201 pack-years, aged 60 to 74 years, underwent a baseline CXR and sputum cytology examination and received five screening rounds with LDCT or a yearly clinical review only in a randomized fashion.
Measurements and Main Results: A total of 1,264 subjects were enrolled in the LDCTarmand 1,186 inthe controlarm. Theirmedian age was 64.0 years (interquartile range, 5), and median smoking exposurewas 45.0 pack-years. The median follow-up was 8.35 years. One hundred four patients (8.23%) were diagnosed with lung cancer in the screening arm (66 by CT), 47 of whom (3.71%) had stage I disease; 72 control patients (6.07%) were diagnosed with lung cancer, with 16 (1.35%) being stage I cases. Lung cancer mortality was 543 per 100,000 personyears (95% confidence interval, 413-700) in the LDCT arm versus 544 per 100,000 person-years (95% CI, 410-709) in the control arm (hazard ratio, 0.993; 95% confidence interval, 0.688-1.433).
Conclusions: Because of its limited statistical power, the results of the DANTE (Detection And screening of early lung cancer with Novel imaging TEchnology) trial do not allow us to make a definitive statement about the efficacy of LDCT screening. However, they underline the importance of obtaining additional data from randomized trials with intervention-free reference arms before the implementation of population screening.
Keywords: lung neoplasms; early diagnosis; screening; spiral computed tomography; randomized controlled trial
Localized, surgically curable stage I-II lung cancers represent only approximately 16% of clinically detected cases (1), a statistic that has remained stagnant for decades. For this reason, screening of high-risk subjects to detect lung tumors before progression to advanced disease was proposed early in the second half of the last century as a potential strategy to curtail lung cancer mortality (2).
However, the randomized trials that followed in the 1970s (3-5) did not demonstrate a reduction in lung cancer mortality...