Prolonged lung cancer screening reduced 10-year mortality in the MILD trial: new confirmation of lung cancer screening efficacy

Abstract Background The National Lung Screening Trial showed that lung cancer (LC) screening by three annual rounds of low-dose computed tomography (LDCT) reduces LC mortality. We evaluated the benefit of prolonged LDCT screening beyond 5 years, and its impact on overall and LC specific mortality at...

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Published in:	Annals of oncology Vol. 30; no. 7; pp. 1162 - 1169
Main Authors:	Pastorino, U, Silva, M, Sestini, S, Sabia, F, Boeri, M, Cantarutti, A, Sverzellati, N, Sozzi, G, Corrao, G, Marchianò, A
Format:	Journal Article
Language:	English
Published:	England Oxford University Press 01.07.2019
Subjects:	Aged Carcinoma, Non-Small-Cell Lung - diagnosis Carcinoma, Non-Small-Cell Lung - mortality Carcinoma, Non-Small-Cell Lung - prevention & control Early Detection of Cancer - statistics & numerical data Female Follow-Up Studies Humans Italy - epidemiology Lung Neoplasms - diagnosis Lung Neoplasms - mortality Lung Neoplasms - prevention & control Male Middle Aged Prognosis Prospective Studies Small Cell Lung Carcinoma - diagnosis Small Cell Lung Carcinoma - mortality Small Cell Lung Carcinoma - prevention & control Survival Rate Italy lung cancer mortality screening early detection overdiagnosis low-dose computed tomography
ISSN:	0923-7534, 1569-8041, 1569-8041
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Abstract	Abstract Background The National Lung Screening Trial showed that lung cancer (LC) screening by three annual rounds of low-dose computed tomography (LDCT) reduces LC mortality. We evaluated the benefit of prolonged LDCT screening beyond 5 years, and its impact on overall and LC specific mortality at 10 years. Design The Multicentric Italian Lung Detection (MILD) trial prospectively randomized 4099 participants, to a screening arm (n = 2376), with further randomization to annual (n = 1190) or biennial (n = 1186) LDCT for a median period of 6 years, or control arm (n = 1723) without intervention. Between 2005 and 2018, 39 293 person-years of follow-up were accumulated. The primary outcomes were 10-year overall and LC specific mortality. Landmark analysis was used to test the long-term effect of LC screening, beyond 5 years by exclusion of LCs and deaths that occurred in the first 5 years. Results The LDCT arm showed a 39% reduced risk of LC mortality at 10 years [hazard ratio (HR) 0.61; 95% confidence interval (CI) 0.39–0.95], compared with control arm, and a 20% reduction of overall mortality (HR 0.80; 95% CI 0.62–1.03). LDCT benefit improved beyond the 5th year of screening, with a 58% reduced risk of LC mortality (HR 0.42; 95% CI 0.22–0.79), and 32% reduction of overall mortality (HR 0.68; 95% CI 0.49–0.94). Conclusions The MILD trial provides additional evidence that prolonged screening beyond 5 years can enhance the benefit of early detection and achieve a greater overall and LC mortality reduction compared with NLST trial. ClinicalTrials.gov identifier NCT02837809.
AbstractList	The National Lung Screening Trial showed that lung cancer (LC) screening by three annual rounds of low-dose computed tomography (LDCT) reduces LC mortality. We evaluated the benefit of prolonged LDCT screening beyond 5 years, and its impact on overall and LC specific mortality at 10 years. The Multicentric Italian Lung Detection (MILD) trial prospectively randomized 4099 participants, to a screening arm (n = 2376), with further randomization to annual (n = 1190) or biennial (n = 1186) LDCT for a median period of 6 years, or control arm (n = 1723) without intervention. Between 2005 and 2018, 39 293 person-years of follow-up were accumulated. The primary outcomes were 10-year overall and LC specific mortality. Landmark analysis was used to test the long-term effect of LC screening, beyond 5 years by exclusion of LCs and deaths that occurred in the first 5 years. The LDCT arm showed a 39% reduced risk of LC mortality at 10 years [hazard ratio (HR) 0.61; 95% confidence interval (CI) 0.39-0.95], compared with control arm, and a 20% reduction of overall mortality (HR 0.80; 95% CI 0.62-1.03). LDCT benefit improved beyond the 5th year of screening, with a 58% reduced risk of LC mortality (HR 0.42; 95% CI 0.22-0.79), and 32% reduction of overall mortality (HR 0.68; 95% CI 0.49-0.94). The MILD trial provides additional evidence that prolonged screening beyond 5 years can enhance the benefit of early detection and achieve a greater overall and LC mortality reduction compared with NLST trial. NCT02837809. The National Lung Screening Trial showed that lung cancer (LC) screening by three annual rounds of low-dose computed tomography (LDCT) reduces LC mortality. We evaluated the benefit of prolonged LDCT screening beyond 5 years, and its impact on overall and LC specific mortality at 10 years.BACKGROUNDThe National Lung Screening Trial showed that lung cancer (LC) screening by three annual rounds of low-dose computed tomography (LDCT) reduces LC mortality. We evaluated the benefit of prolonged LDCT screening beyond 5 years, and its impact on overall and LC specific mortality at 10 years.The Multicentric Italian Lung Detection (MILD) trial prospectively randomized 4099 participants, to a screening arm (n = 2376), with further randomization to annual (n = 1190) or biennial (n = 1186) LDCT for a median period of 6 years, or control arm (n = 1723) without intervention. Between 2005 and 2018, 39 293 person-years of follow-up were accumulated. The primary outcomes were 10-year overall and LC specific mortality. Landmark analysis was used to test the long-term effect of LC screening, beyond 5 years by exclusion of LCs and deaths that occurred in the first 5 years.DESIGNThe Multicentric Italian Lung Detection (MILD) trial prospectively randomized 4099 participants, to a screening arm (n = 2376), with further randomization to annual (n = 1190) or biennial (n = 1186) LDCT for a median period of 6 years, or control arm (n = 1723) without intervention. Between 2005 and 2018, 39 293 person-years of follow-up were accumulated. The primary outcomes were 10-year overall and LC specific mortality. Landmark analysis was used to test the long-term effect of LC screening, beyond 5 years by exclusion of LCs and deaths that occurred in the first 5 years.The LDCT arm showed a 39% reduced risk of LC mortality at 10 years [hazard ratio (HR) 0.61; 95% confidence interval (CI) 0.39-0.95], compared with control arm, and a 20% reduction of overall mortality (HR 0.80; 95% CI 0.62-1.03). LDCT benefit improved beyond the 5th year of screening, with a 58% reduced risk of LC mortality (HR 0.42; 95% CI 0.22-0.79), and 32% reduction of overall mortality (HR 0.68; 95% CI 0.49-0.94).RESULTSThe LDCT arm showed a 39% reduced risk of LC mortality at 10 years [hazard ratio (HR) 0.61; 95% confidence interval (CI) 0.39-0.95], compared with control arm, and a 20% reduction of overall mortality (HR 0.80; 95% CI 0.62-1.03). LDCT benefit improved beyond the 5th year of screening, with a 58% reduced risk of LC mortality (HR 0.42; 95% CI 0.22-0.79), and 32% reduction of overall mortality (HR 0.68; 95% CI 0.49-0.94).The MILD trial provides additional evidence that prolonged screening beyond 5 years can enhance the benefit of early detection and achieve a greater overall and LC mortality reduction compared with NLST trial.CONCLUSIONSThe MILD trial provides additional evidence that prolonged screening beyond 5 years can enhance the benefit of early detection and achieve a greater overall and LC mortality reduction compared with NLST trial.NCT02837809.CLINICALTRIALS.GOV IDENTIFIERNCT02837809. Abstract Background The National Lung Screening Trial showed that lung cancer (LC) screening by three annual rounds of low-dose computed tomography (LDCT) reduces LC mortality. We evaluated the benefit of prolonged LDCT screening beyond 5 years, and its impact on overall and LC specific mortality at 10 years. Design The Multicentric Italian Lung Detection (MILD) trial prospectively randomized 4099 participants, to a screening arm (n = 2376), with further randomization to annual (n = 1190) or biennial (n = 1186) LDCT for a median period of 6 years, or control arm (n = 1723) without intervention. Between 2005 and 2018, 39 293 person-years of follow-up were accumulated. The primary outcomes were 10-year overall and LC specific mortality. Landmark analysis was used to test the long-term effect of LC screening, beyond 5 years by exclusion of LCs and deaths that occurred in the first 5 years. Results The LDCT arm showed a 39% reduced risk of LC mortality at 10 years [hazard ratio (HR) 0.61; 95% confidence interval (CI) 0.39–0.95], compared with control arm, and a 20% reduction of overall mortality (HR 0.80; 95% CI 0.62–1.03). LDCT benefit improved beyond the 5th year of screening, with a 58% reduced risk of LC mortality (HR 0.42; 95% CI 0.22–0.79), and 32% reduction of overall mortality (HR 0.68; 95% CI 0.49–0.94). Conclusions The MILD trial provides additional evidence that prolonged screening beyond 5 years can enhance the benefit of early detection and achieve a greater overall and LC mortality reduction compared with NLST trial. ClinicalTrials.gov identifier NCT02837809.
Author	Marchianò, A Sestini, S Sozzi, G Sabia, F Boeri, M Cantarutti, A Sverzellati, N Corrao, G Pastorino, U Silva, M
Author_xml	– sequence: 1 givenname: U orcidid: 0000-0001-9974-7902 surname: Pastorino fullname: Pastorino, U email: ugo.pastorino@istitutotumori.mi.it organization: Unit of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan – sequence: 2 givenname: M orcidid: 0000-0002-2538-7032 surname: Silva fullname: Silva, M organization: Unit of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan – sequence: 3 givenname: S surname: Sestini fullname: Sestini, S organization: Unit of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan – sequence: 4 givenname: F orcidid: 0000-0001-7334-8962 surname: Sabia fullname: Sabia, F organization: Unit of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan – sequence: 5 givenname: M surname: Boeri fullname: Boeri, M organization: Tumour Genomics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan – sequence: 6 givenname: A surname: Cantarutti fullname: Cantarutti, A organization: Division of Biostatistics, Department of Statistics and Quantitative Methods, Epidemiology and Public Health, University of Milano-Bicocca, Milan – sequence: 7 givenname: N surname: Sverzellati fullname: Sverzellati, N organization: Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma – sequence: 8 givenname: G surname: Sozzi fullname: Sozzi, G organization: Tumour Genomics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan – sequence: 9 givenname: G surname: Corrao fullname: Corrao, G organization: Division of Biostatistics, Department of Statistics and Quantitative Methods, Epidemiology and Public Health, University of Milano-Bicocca, Milan – sequence: 10 givenname: A surname: Marchianò fullname: Marchianò, A organization: Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Copyright	The Author(s) 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology.
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Keywords	lung cancer mortality screening early detection overdiagnosis low-dose computed tomography
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References	31046087 - Ann Oncol. 2019 Jul 1;30(7):1040-1043 31118491 - Nat Rev Clin Oncol. 2019 Sep;16(9):529-530 31168572 - Ann Oncol. 2019 Oct 1;30(10):1672
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Snippet	Abstract Background The National Lung Screening Trial showed that lung cancer (LC) screening by three annual rounds of low-dose computed tomography (LDCT)... The National Lung Screening Trial showed that lung cancer (LC) screening by three annual rounds of low-dose computed tomography (LDCT) reduces LC mortality. We...
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SubjectTerms	Aged Carcinoma, Non-Small-Cell Lung - diagnosis Carcinoma, Non-Small-Cell Lung - mortality Carcinoma, Non-Small-Cell Lung - prevention & control Early Detection of Cancer - statistics & numerical data Female Follow-Up Studies Humans Italy - epidemiology Lung Neoplasms - diagnosis Lung Neoplasms - mortality Lung Neoplasms - prevention & control Male Middle Aged Prognosis Prospective Studies Small Cell Lung Carcinoma - diagnosis Small Cell Lung Carcinoma - mortality Small Cell Lung Carcinoma - prevention & control Survival Rate
Title	Prolonged lung cancer screening reduced 10-year mortality in the MILD trial: new confirmation of lung cancer screening efficacy
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