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Evidence of Benefit

Chest X-Ray and Sputum Cytology

The most common screening tests for lung cancer are the chest x-ray and sputum cytology. Early studies evaluating these modalities include the following:

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  1. Philadelphia Pulmonary Neoplasm Research Project,[1] a nonrandomized, uncontrolled study that began in 1951.
  2. Veterans Administration study,[2] a nonrandomized, uncontrolled study that was conducted from 1958 to 1961.
  3. South London Lung Cancer Study,[3] a nonrandomized, uncontrolled study that was conducted from 1955 to 1963.
  4. North London Cancer Study,[4,5] a randomized study that was conducted in the early 1960s and randomly assigned industrial firms to screening and no screening groups.
  5. Kaiser Foundation Health Plan multiphasic screening trial,[6,7] a controlled trial that began in 1964 and included annual chest x-ray, spirometry, and medical questionnaire as part of the multiphasic screening.

None of these studies reported a statistically significant benefit of screening on lung cancer mortality. As an example, the South London study reported an increase in survival from the time of diagnosis of screen-detected lung cancer cases compared with other cases found in the same geographical region. There was, however, no adjustment for self-selection bias, lead-time bias, overdiagnosis bias, or length bias. Additionally, these studies were small, with a short follow-up period of typically less than 10 years, so that a small-to-moderate size or long-term effect was not demonstrable.

Other lung cancer screening investigations include a randomized trial in Czechoslovakia,[8] a nonrandomized but controlled trial in the former German Democratic Republic (GDR),[9] and case-control studies in the former GDR [10] and Japan.[11,12] The participants in the randomized arms of the Czechoslovakian study were screened with x-ray and cytology at two different frequencies, semiannual versus every 3 years. There was no unscreened control group. No difference in lung cancer mortality was observed; the relative risk (RR, screen group/control group) was 1.36 (95% confidence interval [CI], 0.94-1.98). The GDR nonrandomized study used semiannual chest fluoroscopy over a 6-year period in the intervention arm, while control patients were scheduled to undergo the same exam at 1-year to 2-year intervals. Allocation was based on district of residence. No reduction was observed in lung cancer mortality; the RR was 1.34 (95% CI, 0.94-1.98). Chest x-rays originally used for control of tuberculosis were evaluated in the German case-control study. The odds ratio (OR) showed no association between lung cancer death and having received a screening chest x-ray in both a general population-based control group (OR = 0.9; 95% CI, 0.5-1.5) and a hospital-based control group (OR = 1.1; 95% CI, 0.7-1.8).[10] X-ray histories among deceased lung cancer cases and matched controls were considered in a Japanese case-control study. In contrast to the German study, there was a suggestion of some screening benefit; the OR of dying from lung cancer for those screened within 12 months versus those not screened was 0.72 (95% CI, 0.50-1.03).[11] A meta-analysis of four other case-control studies conducted in Japan suggested mortality reductions of approximately 40%,[13] but potential for bias in these studies has been noted.[11]

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WebMD Public Information from the National Cancer Institute

Last Updated: October 07, 2011
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