Italian lung cancer screening findings consistent with US National Lung Screening Trial results (ITALUNG)

Reference

Paci E, Puliti D, Pegna AL, et al, for the ITALUNG Working Group. Mortality, survival and incidence rates in the ITALUNG randomised lung cancer screening trial. Thorax 2017;72(9):825-831.

Synopsis

Lung cancer screening is controversial because of concerns of the harms of follow-up scans, biopsies, and surgeries, and uncertainty regarding benefit. The ITALUNG trial randomized 3206 smokers to low-dose computed tomography screening annually or to usual care for 4 years. The patients' average age was 61 years and 64% were male, with a median of 39 pack years of smoking. This report provides results from a 9.3-year period: 4 years of the screening intervention plus a median 5.3-year follow-up. The study was much smaller than the NLST on which the US Preventive Services Task Force recommendations were based. These authors found strong trends regarding reductions in all-cause mortality (105 vs 127 deaths per 10,000 person years; rate ratio 0.83; 95% CI 0.67 - 1.03) and lung cancer–specific mortality (29.3 vs 42.1 deaths/10,000 person years; rate ratio 0.70; 0.47 - 1.03). These findings are similar in magnitude and direction to those of the NLST. During the 9.3-year period, 67 lung cancers were diagnosed in the screened group and 71 in the control group. The number of lung cancers detected during the screening period was 55% higher in the screened group, which is to be expected, and was then 45% lower in the 5-year postscreening period, suggesting that overdiagnosis was not an important problem (if it was, one would have expected to see more lung cancer diagnosed in the screened group cumulatively).