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Peter B. Bach, MD, MAPP; James R. Jett, MD; Ugo Pastorino, MD; Melvyn S. Tockman, MD, PhD; Stephen J. Swensen, MD, MMM; Colin B. Begg, PhD

JAMA. 2007;297:953-961.

Context  Current and former smokers are currently being screened for lung cancer with computed tomography (CT), although there are limited data on the effect screening has on lung cancer outcomes. Randomized controlled trials assessing CT screening are currently under way.

Objective  To assess whether screening may increase the frequency of lung cancer diagnosis and lung cancer resection or may reduce the risk of a diagnosis of advanced lung cancer or death from lung cancer.

Design, Setting, and Participants  Longitudinal analysis of 3246 asymptomatic current or former smokers screened for lung cancer beginning in 1998 either at 1 of 2 academic medical centers in the United States or an academic medical center in Italy with follow-up for a median of 3.9 years.

Intervention  Annual CT scans with comprehensive evaluation and treatment of detected nodules.

Main Outcome Measures  Comparison of predicted with observed number of new lung cancer cases, lung cancer resections, advanced lung cancer cases, and deaths from lung cancer.

Results  There were 144 individuals diagnosed with lung cancer compared with 44.5 expected cases (relative risk [RR], 3.2; 95% confidence interval [CI], 2.7-3.8; P<.001). There were 109 individuals who had a lung resection compared with 10.9 expected cases (RR, 10.0; 95% CI, 8.2-11.9; P<.001). There was no evidence of a decline in the number of diagnoses of advanced lung cancers (42 individuals compared with 33.4 expected cases) or deaths from lung cancer (38 deaths due to lung cancer observed and 38.8 expected; RR, 1.0; 95% CI, 0.7-1.3; P = .90).

Conclusions  Screening for lung cancer with low-dose CT may increase the rate of lung cancer diagnosis and treatment, but may not meaningfully reduce the risk of advanced lung cancer or death from lung cancer. Until more conclusive data are available, asymptomatic individuals should not be screened outside of clinical research studies that have a reasonable likelihood of further clarifying the potential benefits and risks.

Author Affiliations: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (Drs Bach and Begg); Division of Pulmonary Medicine and Oncology (Dr Jett), Department of Radiology (Dr Swensen), Mayo Clinic, Rochester, Minn; Division of Thoracic Surgery, Istituto Tumori, Milan, Italy (Dr Pastorino); and Department of Cancer Prevention and Control, Moffitt Cancer Center, Tampa, Fla (Dr Tockman).

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