Assessment of lung cancer mortality reduction after chest X-ray screening in smokers: A population-based cohort study in Varese, Italy

作者：Dominioni Lorenzo^*; Poli Albino; Mantovani William; Pisani Salvatore; Rotolo Nicola; Paolucci Massimo; Sessa Fausto; Conti Valentina; D' Ambrosio Vincenzo; Paddeu Antonio; Imperatori Andrea

来源：Lung Cancer, 2013, 80(1): 50-54.

DOI：10.1016/j.lungcan.2012.12.014

• Lung cancer
• Mortality
• Smoking
• Cohort study
• Chest X-ray screening
• Population-based

Background: The effectiveness of screening for lung cancer (LC) in smokers on a population level, as distinct from the special circumstances that may apply in a randomized trial of selected volunteers, has not been thoroughly investigated. Here we evaluate by the standardized mortality ratio (SMR) indicator the impact of a chest X-ray (CXR) screening programme carried out at community level on LC mortality in smokers. %26lt;br%26gt;Methods: All smokers of %26gt;10 pack-years, of both genders, ages 45-75 years, resident in 50 communities of the Province of Varese, Italy, screening-eligible, in 1997 were invited by their National Health Service (NHS) general practitioner physicians to a nonrandomized programme of five annual CXR screenings. The entire invitation-to-screen cohort (n=5815 subjects) received NHS usual care, with the addition of CXR exams in volunteer participants (21% of invitees), and was observed through December 2006. To overcome participants%26apos; selection bias of LC mortality assessment, for the entire invitation-to-screen cohort we estimated the LC-specific SMR, based on the local reference population receiving the NHS usual care. %26lt;br%26gt;Results: Over the 8-year period 1999-2006, a total of 172 cumulative LC deaths were observed in the invitation-to-screen cohort; 210 were expected based on the reference population. Each year in the invited cohort the observed LC deaths were fewer than expected. The cumulative LC SMR was 0.82 (95%CI, 0.67-0.99; p = 0.048), suggesting that LC mortality was reduced by 18% with CXR screening. %26lt;br%26gt;Conclusion: Implementation of a CXR screening programme at community level was associated with a significant reduction of LC mortality in smokers.

• 出版日期2013-4