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1 From the Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital, Finland
2 From the Division of Cancer Prevention and Control, National Cancer Institute, Bethesda, MD
3 From the Department of Nutrition, National Public Health Institute, Helsinki, Finland
4 From the Department of Public Health, University of Helsinki, Finland
Eija-Riitta Salomaa, MD, Turku University Hospital, Department of Pulmonary Diseases and Clinical Allergology, FIN-21540 Preitilä, Finland; e-mail: eirisa{at}utu.fi
Background: The prognosis of patients with lung cancer is better when the diagnosis is made early; the disease is localized, and radical surgery is possible. Screening for lung cancer with mass radiography or sputum cytology should contribute to a more favorable prognosis. Large-scale screening studies have improved the survival rates for lung cancer but have yielded no reduction in mortality rates.
Methods: The histologic types, stages, treatments, and survival rates were studied in 93 men who were found to have lung cancer in a single chest radiograph screening of more than 33,000 men who smoked and were 50 to 69 years old ("screened cases"), and in 239 men of the same age range whose lung cancer was detected through ordinary health care system ("other cases") during the screening period.
Results: The distribution of the histology was similar in the two groups, but screening detected more instances of early-stage disease that were resectable more often than in the other group (37 vs 19%). The 5-year survival rate for men in the screened cases was 19%, and that of men in the other cases was 10% (relative risk, 0.65; 95% confidence interval [CI], 0.50 to 0.84). The survival rate of men in the screened cases remained significantly higher than that of men in the other cases even after adjustments for age, smoking status, histology, stage of the disease, and resectability of the disease (relative risk, 0.74; 95% CI, 0.55 to 1.00).
Conclusions: According to this study, chest radiograph screening might improve the prognosis of lung cancer. Our results are, however, subject to many factors that were only partially controlled for, and they should be interpreted cautiously.
Key Words: lung cancer • screening • survival
Submitted on January 23, 1998
Accepted on July 2, 1998
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