Screening by Chest Radiograph and Lung Cancer Mortality

Oken, Martin M.; Hocking, William G.; Kvale, Paul A.; Andriole, Gerald L.; Buys, Saundra S.; Church, Timothy R.; Crawford, E. David; Fouad, Mona N.; Isaacs, Claudine; Reding, Douglas J.; Weissfeld, Joel L.; Yokochi, Lance; O’Brien, Barbara; Ragard, Lawrence R.; Rathmell, Joshua M.; Riley, Thomas L.; Wright, Patrick; Caparaso, Neil; Hu, Ping; Izmirlian, Grant; Pinsky, Paul F.; Prorok, Philip C.; Kramer, Barnett S.; Miller, Anthony B.; Gohagan, John K.; Berg, Christine D.; Team, for the PLCO Project

doi:10.1001/jama.2011.1591

Cited by 539 publications

(160 citation statements)

References 13 publications

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“…Because the survival rate is good if the disease is detected early, there has been a long-standing interest in using transvaginal ultrasonography or serum levels of the tumor marker CA125 to give an indication of disease before symptoms are manifest. However, although there is some evidence for a survival benefit in screen-detected cases, the largest randomized trial to date found no reduction in mortality (Buys et al, 2011). There was also significant morbidity as a consequence of follow-up investigations for women with false positive findings.…”

Section: Kathryn Robbmentioning

confidence: 97%

See 1 more Smart Citation

Screening for prevention and early diagnosis of cancer.

Wardle

Robb

Vernon

et al. 2015

American Psychologist

126

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Section: Kathryn Robbmentioning

confidence: 97%

“…efforts focused on high-risk groups such as smokers and people with preexisting lung disease (Aberle et al, 2013;Marcus et al, 2006;Oken et al, 2011). A recent review of low-dose CT screening concluded that it may be beneficial for very high-risk individuals but that the harms are not well enough understood (Bach et al, 2012).…”

Section: Kathryn Robbmentioning

confidence: 99%

Screening for prevention and early diagnosis of cancer.

Wardle

Robb

Vernon

et al. 2015

American Psychologist

126

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“…No mortality benefit was observed for the chest X-ray arm. 27,28 Low-dose computed tomography lung cancer screening Low-dose computed tomography, which was introduced in the late 1990s, offers a major advance in imaging technology. 29 LDCT is more sensitive than chest radiography, and has enabled detection of lung tumours that are < 1 cm.…”

Section: Risk Factors For Lung Cancermentioning

confidence: 99%

“…These subjects were randomised to LDCT or chest X-ray, with lung cancer mortality as the outcome. The X-ray control arm of the study comprised data from those individuals who had been screened in the PLCO 27 trial. The NLST reported a 20% relative reduction in lung cancer mortality in the LDCT arm.…”

Section: National Lung Cancer Screening Trialmentioning

confidence: 99%

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

Field

Duffy

Baldwin

et al. 2016

Health Technol Assess

214

216

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BackgroundLung cancer kills more people than any other cancer in the UK (5-year survival < 13%). Early diagnosis can save lives. The USA-based National Lung Cancer Screening Trial reported a 20% relative reduction in lung cancer mortality and 6.7% all-cause mortality in low-dose computed tomography (LDCT)-screened subjects.ObjectivesTo (1) analyse LDCT lung cancer screening in a high-risk UK population, determine optimum recruitment, screening, reading and care pathway strategies; and (2) assess the psychological consequences and the health-economic implications of screening.DesignA pilot randomised controlled trial comparing intervention with usual care. A population-based risk questionnaire identified individuals who were at high risk of developing lung cancer (≥ 5% over 5 years).SettingThoracic centres with expertise in lung cancer imaging, respiratory medicine, pathology and surgery: Liverpool Heart & Chest Hospital, Merseyside, and Papworth Hospital, Cambridgeshire.ParticipantsIndividuals aged 50–75 years, at high risk of lung cancer, in the primary care trusts adjacent to the centres.InterventionsA thoracic LDCT scan. Follow-up computed tomography (CT) scans as per protocol. Referral to multidisciplinary team clinics was determined by nodule size criteria.Main outcome measuresPopulation-based recruitment based on risk stratification; management of the trial through web-based database; optimal characteristics of CT scan readers (radiologists vs. radiographers); characterisation of CT-detected nodules utilising volumetric analysis; prevalence of lung cancer at baseline; sociodemographic factors affecting participation; psychosocial measures (cancer distress, anxiety, depression, decision satisfaction); and cost-effectiveness modelling.ResultsA total of 247,354 individuals were approached to take part in the trial; 30.7% responded positively to the screening invitation. Recruitment of participants resulted in 2028 in the CT arm and 2027 in the control arm. A total of 1994 participants underwent CT scanning: 42 participants (2.1%) were diagnosed with lung cancer; 36 out of 42 (85.7%) of the screen-detected cancers were identified as stage 1 or 2, and 35 (83.3%) underwent surgical resection as their primary treatment. Lung cancer was more common in the lowest socioeconomic group. Short-term adverse psychosocial consequences were observed in participants who were randomised to the intervention arm and in those who had a major lung abnormality detected, but these differences were modest and temporary. Rollout of screening as a service or design of a full trial would need to address issues of outreach. The health-economic analysis suggests that the intervention could be cost-effective but this needs to be confirmed using data on actual lung cancer mortality.ConclusionsThe UK Lung Cancer Screening (UKLS) pilot was successfully undertaken with 4055 randomised individuals. The data from the UKLS provide evidence that adds to existing data to suggest that lung cancer screening in the UK could potentially be implemented in the 60–75 years age group, selected via the Liverpool Lung Project risk model version 2 and using CT volumetry-based management protocols.Future workThe UKLS data will be pooled with the NELSON (Nederlands Leuvens Longkanker Screenings Onderzoek: Dutch–Belgian Randomised Lung Cancer Screening Trial) and other European Union trials in 2017 which will provide European mortality and cost-effectiveness data. For now, there is a clear need for mortality results from other trials and further research to identify optimal methods of implementation and delivery. Strategies for increasing uptake and providing support for underserved groups will be key to implementation.Trial registrationCurrent Controlled Trials ISRCTN78513845.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 40. See the NIHR Journals Library website for further project information.

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“…645 (9) 542 (9) 392 (8) 911 (9) 1284 (9) 2260 (9) Somewhat important 1712 (27) 1824 (26) 1495 (25) 1142 (24) 2604 (25) 3574 (26) 6314 (26) Important or very important 3964 (63) 4536 (65) 3901 (66) 3140 (67) 6824 (66) 8733 (64) 16047 (65) Importance of interviews with PLCO participants Not important 808 (13) 922 (13) 730 (12) 553 (12) 1398 (14) 1628 (12) 3108 (13) Somewhat important 1836 (29) 1991 (28) 1696 (28) 1279 (27) 3058 (30) 3750 (27) 6967 (28) Important or very important 3637 (58) 4141 (59) 3542 (59) 2852 (61) 5881 (57) 8311 (61) 4632 (59) Information about scientific articles published using PLCO data Not important 204 (3) 260 (4) 225 (4) 211 (5) 417 (4) 34 (5) 943 (4) Somewhat important 594 (10)…”

Section: Discussionmentioning

confidence: 99%

Participants Views of Retention Materials Used in the PLCO Cancer Screening Trial

Pretzel

Andrews

Broski

et al. 2015

Clinical Medicine & Research

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Objective: To obtain information from participants in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial regarding their perception of the retention materials employed by the screening centers. Also, to determine the viability of using email or the internet as a data collection tool with an older population.Design: Three of ten PLCO screening centers queried participants towards the end of the study (2010) as to their opinions of the various retention materials and whether they would have been willing to use electronic communication for study activities, had the option been available. Setting:The questionnaires were administered by mail, and responses were returned to the originating screening center. Participants:The participants in this study consisted of all the active participants at three PLCO screening centers: the University of Colorado Anschutz Medical Campus, the University of Utah, and Henry Ford Health System. Methods:A short, self-administered questionnaire was mailed to all active participants at three PLCO centers (n=41,482). This was a one-time mailing with no follow-up, as the responses were designed to be anonymous in order to obtain the most honest responses. Results:The response rate was 62%. Of respondents, 97% reported their PLCO experience was good or excellent. Nearly 50% of respondents indicated that receipt of an annual newsletter made them more likely to participate; newsletter features they reported as most important were those that conveyed information on cancer, study findings, and how their data were being used. Results did not support study coordinators' suppositions that receipt of a token gift or birthday card by participants was important for retention. Fewer than 30% of respondents indicated that they would have been unwilling to use a secure website to complete study forms. Conclusion:These data indicate the importance of querying participants rather than relying on impressions of study staff, and also indicate that the internet will be a viable means of data collection in future prevention studies that include older Americans.

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Screening by Chest Radiograph and Lung Cancer Mortality

Abstract: clinicaltrials.gov Identifier: NCT00002540.

Cited by 539 publications

References 13 publications

Screening for prevention and early diagnosis of cancer.

Screening for prevention and early diagnosis of cancer.

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

Participants Views of Retention Materials Used in the PLCO Cancer Screening Trial

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