Screening by Chest Radiograph and Lung Cancer Mortality The Prostate, Lung, Colorectal, and Ovarian (PLCO) Randomized Trial

被引：465

作者：

Oken, Martin M. ^{[4
]}

Hocking, Willam G. ^{[5
]}

Kvale, Paul A. ^{[6
]}

Andriole, Gerald L. ^{[7
]}

Buys, Saundra S. ^{[8
]}

Church, Timothy R. ^{[4
]}

Crawford, E. David ^{[9
]}

Fouad, Mona N. ^{[10
]}

Isaacs, Claudine ^{[11
]}

Reding, Douglas J. ^{[5
]}

Weissfeld, Joel L. ^{[12
]}

Yokochi, Lance A. ^{[13
]}

O'Brien, Barbara ^{[14
]}

Ragard, Lawrence R. ^{[14
]}

Rathmell, Joshua M. ^{[15
]}

Riley, Thomas L. ^{[15
]}

Wright, Patrick ^{[15
]}

Caparaso, Neil ^{[16
]}

Hu, Ping ^{[1
,2
]}

Izmirlian, Grant ^{[1
,2
]}

Pinsky, Paul F. ^{[1
,2
]}

Prorok, Philip C. ^{[1
,2
]}

Kramer, Barnett S. ^{[3
]}

Miller, Anthony B. ^{[17
]}

Gohagan, John K. ^{[18
]}

Berg, Christine D. ^{[1
,2
]}

机构：

[1] NCI, Biometry Res Grp, Canc Prevent Div, NIH, Bethesda, MD 20892 USA

[2] NCI, Early Detect Res Grp, Canc Prevent Div, NIH, Bethesda, MD 20892 USA

[3] NCI, Phys Data Query Screening & Prevent Editorial Boa, NIH, Bethesda, MD 20892 USA

[4] Univ Minnesota, Sch Publ Hlth, Minneapolis, MN USA

[5] Marshfield Clin Fdn Med Res & Educ, Marshfield, WI 54449 USA

[6] Henry Ford Hlth Syst, Detroit, MI USA

[7] Washington Univ, St Louis, MO USA

[8] Univ Utah, Huntsman Canc Inst, Salt Lake City, UT USA

[9] Univ Colorado, Denver, CO 80202 USA

[10] Univ Alabama Birmingham, Sch Med, Birmingham, AL USA

[11] Georgetown Univ, Lombardi Canc Ctr, Washington, DC USA

[12] Univ Pittsburgh, Med Ctr Canc Pavil, Pittsburgh, PA USA

[13] Pacific Hlth Res & Educ Inst, Honolulu, HI USA

[14] Westat Corp, Rockville, MD USA

[15] Informat Management Serv Inc, Rockville, MD USA

[16] NCI, Div Canc Epidemiol & Genet, NIH, Bethesda, MD 20892 USA

[17] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada

[18] NIH, Off Dis Prevent, Bethesda, MD 20892 USA

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2011年 / 306卷 / 17期

基金：

美国国家卫生研究院;

关键词：

D O I：

10.1001/jama.2011.1591

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Context The effect on mortality of screening for lung cancer with modern chest radiographs is unknown. 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. Design, Setting, and Participants Randomized controlled trial that involved 154 901 participants aged 55 through 74 years, 77 445 of whom were assigned to annual screenings and 77 456 to usual care at 1 of 10 screening centers across the United States between November 1993 and July 2001. The data from a subset of eligible participants for the National Lung Screening Trial (NLST), which compared chest radiograph with spiral computed tomographic (CT) screening, were analyzed. Intervention Participants in the intervention group were offered annual postero-anterior view chest radiograph for 4 years. Diagnostic follow-up of positive screening results was determined by participants and their health care practitioners. Participants in the usual care group were offered no interventions and received their usual medical care. All diagnosed cancers, deaths, and causes of death were ascertained through the earlier of 13 years of follow-up or until December 31, 2009. Main Outcome Measures Mortality from lung cancer. Secondary outcomes included lung cancer incidence, complications associated with diagnostic procedures, and all-cause mortality. Results Screening adherence was 86.6% at baseline and 79% to 84% at years 1 through 3; the rate of screening use in the usual care group was 11%. Cumulative lung cancer incidence rates through 13 years of follow-up were 20.1 per 10 000 person-years in the intervention group and 19.2 per 10 000 person-years in the usual care group (rate ratio [RR]; 1.05, 95% CI, 0.98-1.12). A total of 1213 lung cancer deaths were observed in the intervention group compared with 1230 in usual care group through 13 years (mortality RR, 0.99; 95% CI, 0.87-1.22). Stage and histology were similar between the 2 groups. The RR of mortality for the subset of participants eligible for the NLST, over the same 6-year follow-up period, was 0.94 (95% CI, 0.81-1.10). Conclusion Annual screening with chest radiograph did not reduce lung cancer mortality compared with usual care.

引用

页码：1865 / 1873

页数：9

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