Lung Cancer Screening With X-Rays Isn't Beneficial

Conway Tan

Routine X ray screenings do not prevent cancer death

+ More than 150,000 Americans aged 55-74 + 13 years, first 4 years, 77445 were assigned to annual screenings, 77456 were not. + About 1200 deaths in both groups + Of the 1,696 cancers diagnosed among those in the X-ray group, about 70% of the cancers were found during the years after the screening period ended.

+ X ray screenings in healthy people without symptoms are "a waste of time," plus they can lead to false-positive results that may lead to invasive and potentially harmfull tests.

"We were really hoping chest X-rays might be beneficial," partly because they are relatively inexpensive - about $60 versus hundreds and sometimes thousands of dollars for CT scans, Dr. Berg said

+ X-ray still useful for symptomatic patients + CT provides much detailed images + But can also yield false positive results, unlikely to be recommended

Objective
+ To evaluate the effect on mortality of screening for lung cancer using radiographs in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.

Intervention
+ Annual posteroanterior view chest radiograph for 4 years. + Control group: No interventions and received their usual medical care. + Definition of screen diagnosed case = 9 months from a positive screen, or the evaluation linked to the positive screen.

Result - through 13 years

+ Cumulative lung cancer incidence = -- 20.1 per 10 000 person-years in the intervention group -- 19.2 per 10 000 person-years in the usual care group + Death observed = -- 1213 in the intervention group -- 1230 in usual care group

Lung Cancer Incidence by Year

Lung Cancer Mortality by Year

Conclusion
Annual chest radiographic screening for up to 4 years did not have an effect on cumulative lung cancer mortality.

Doubt 1: Smokers out there?

+ Controlled for smokers -- Straitified by screening center, sex, and age, no eligibility requirement concerning smoking -- 45% of the participants reported never smoking, 10% were smokers and the rest were previous smokers when they enrolled in the study.

Doubt 2: Data bias?

+ Diagnose bias: -- Standardized. Anomaly was noted, then advised to seek diagnostic evaluation, result decided by the patients and their primary physicians, not by trial protocol

Doubt 3: Dead man reporting?

+ Method: Annual study questionnaire mailed, if no response, repeated mailing and phonecall. All data supplement by the National Data (death certificate). Since they are not always true, all deaths related to cancer (no matter what kind or possible metastasis) were reviewed by blinded reviewers.

Doubt 4: Contamination?
+ No clean cut control: no interventions and received their usual medical care. + Sojourn time: -- period in which tumou can be asymptotically detected by chest X-ray = 1-4 years. -- Any cancer diagnosed after the Sojourn time could not have been affected by this screening.