Screening for lung cancer. A critique of the mayo lung project

Authors

  • Robert S. Fontana MD,

    Corresponding author
    1. Division of Thoracic Diseases and Internal Medicine, Section of Surgical Pathology, Section of Biostatistics, Department of Diagnostic Radiology, and Section of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and the Section of Thoracic Diseases and Department of Diagnostic Radiology, Mayo Clinic Scottsdale, Scottsdale, Arizona
    • Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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  • David R. Sanderson MD,

    1. Division of Thoracic Diseases and Internal Medicine, Section of Surgical Pathology, Section of Biostatistics, Department of Diagnostic Radiology, and Section of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and the Section of Thoracic Diseases and Department of Diagnostic Radiology, Mayo Clinic Scottsdale, Scottsdale, Arizona
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  • Lewis B. Woolner MD,

    1. Division of Thoracic Diseases and Internal Medicine, Section of Surgical Pathology, Section of Biostatistics, Department of Diagnostic Radiology, and Section of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and the Section of Thoracic Diseases and Department of Diagnostic Radiology, Mayo Clinic Scottsdale, Scottsdale, Arizona
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  • William F. Taylor PhD,

    1. Division of Thoracic Diseases and Internal Medicine, Section of Surgical Pathology, Section of Biostatistics, Department of Diagnostic Radiology, and Section of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and the Section of Thoracic Diseases and Department of Diagnostic Radiology, Mayo Clinic Scottsdale, Scottsdale, Arizona
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  • W. Eugene Miller MD,

    1. Division of Thoracic Diseases and Internal Medicine, Section of Surgical Pathology, Section of Biostatistics, Department of Diagnostic Radiology, and Section of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and the Section of Thoracic Diseases and Department of Diagnostic Radiology, Mayo Clinic Scottsdale, Scottsdale, Arizona
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  • John R. Muhm MD,

    1. Division of Thoracic Diseases and Internal Medicine, Section of Surgical Pathology, Section of Biostatistics, Department of Diagnostic Radiology, and Section of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and the Section of Thoracic Diseases and Department of Diagnostic Radiology, Mayo Clinic Scottsdale, Scottsdale, Arizona
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  • Philip E. Bernatz MD,

    1. Division of Thoracic Diseases and Internal Medicine, Section of Surgical Pathology, Section of Biostatistics, Department of Diagnostic Radiology, and Section of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and the Section of Thoracic Diseases and Department of Diagnostic Radiology, Mayo Clinic Scottsdale, Scottsdale, Arizona
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  • W. Spencer Payne MD,

    1. Division of Thoracic Diseases and Internal Medicine, Section of Surgical Pathology, Section of Biostatistics, Department of Diagnostic Radiology, and Section of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and the Section of Thoracic Diseases and Department of Diagnostic Radiology, Mayo Clinic Scottsdale, Scottsdale, Arizona
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  • Peter C. Pairolero MD,

    1. Division of Thoracic Diseases and Internal Medicine, Section of Surgical Pathology, Section of Biostatistics, Department of Diagnostic Radiology, and Section of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and the Section of Thoracic Diseases and Department of Diagnostic Radiology, Mayo Clinic Scottsdale, Scottsdale, Arizona
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  • Erik J. Bergstralh MS

    1. Division of Thoracic Diseases and Internal Medicine, Section of Surgical Pathology, Section of Biostatistics, Department of Diagnostic Radiology, and Section of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and the Section of Thoracic Diseases and Department of Diagnostic Radiology, Mayo Clinic Scottsdale, Scottsdale, Arizona
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Abstract

The National Cancer Institute of the United States recently sponsored three large-scale, randomized controlled trials of screening for early lung cancer. The trials were conducted at the Johns Hopkins Medical Institutions, the Memorial Sloan-Kettering Cancer Center, and the Mayo Clinic. Participants were middle-aged and older men who were chronic heavy cigarette smokers and thus at high risk of developing lung cancer. Screening procedures were chest radiography and sputum cytology, the only screening tests of established value for detecting early stage, asymptomatic lung cancer. In the Hopkins and Memorial trials the study population was offered yearly chest radiography plus sputum cytology every 4 months. The control population was offered yearly chest radiography only. In these trials the addition of sputum cytology appeared to confer no lung cancer mortality rate advantage. The Mayo Clinic trial compared offering chest radiography and sputum cytology every 4 months to offering advice that the two tests be obtained once a year. This trial demonstrated significantly increased lung cancer detection, resectability, and survivorship in the group offered screening every 4 months compared with the control group. However, there was no significant difference in lung cancer mortality rate between the two groups. The statistical power of these trials was somewhat limited. Nevertheless, results do not justify recommending large-scale radiologic or cytologic screening for early lung cancer at this time.

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