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
Online Access:Get full text
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Summary: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.
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ISSN:0923-7534
1569-8041
1569-8041
DOI:10.1093/annonc/mdz117