Assessment of lung cancer mortality reduction after chest X-ray screening in smokers: A population-based cohort study in Varese, Italy

被引:15
作者
Dominioni, Lorenzo [1 ]
Poli, Albino [2 ]
Mantovani, William [2 ]
Pisani, Salvatore [3 ]
Rotolo, Nicola [1 ]
Paolucci, Massimo [4 ]
Sessa, Fausto [5 ]
Conti, Valentina [1 ]
D'Ambrosio, Vincenzo [6 ]
Paddeu, Antonio [7 ]
Imperatori, Andrea [1 ]
机构
[1] Univ Insubria, Ctr Thorac Surg, Osped Circolo, I-21100 Varese, Italy
[2] Univ Verona, Dept Publ Hlth & Community Med, I-37100 Verona, Italy
[3] Azienda Sanit Locale, Epidemiol Observ, Varese, Italy
[4] Osped S Antonio Abate, Dept Radiol, Gallarate, Italy
[5] Univ Insubria, Dept Surg & Morphol Sci, Varese, Italy
[6] Osped S Antonio Abate, Thorac Med Unit, Gallarate, Italy
[7] Osped S Anna, Resp Care Unit, San Fermo Battaglia, Como, Italy
关键词
Lung cancer; Mortality; Smoking; Cohort study; Chest X-ray screening; Population-based; PROSTATE; DESIGN;
D O I
10.1016/j.lungcan.2012.12.014
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: The effectiveness of screening for lung cancer (LC) in smokers on a population level, as distinct from the special circumstances that may apply in a randomized trial of selected volunteers, has not been thoroughly investigated. Here we evaluate by the standardized mortality ratio (SMR) indicator the impact of a chest X-ray (CXR) screening programme carried out at community level on LC mortality in smokers. Methods: All smokers of >10 pack-years, of both genders, ages 45-75 years, resident in 50 communities of the Province of Varese, Italy, screening-eligible, in 1997 were invited by their National Health Service (NHS) general practitioner physicians to a nonrandomized programme of five annual CXR screenings. The entire invitation-to-screen cohort (n=5815 subjects) received NHS usual care, with the addition of CXR exams in volunteer participants (21% of invitees), and was observed through December 2006. To overcome participants' selection bias of LC mortality assessment, for the entire invitation-to-screen cohort we estimated the LC-specific SMR, based on the local reference population receiving the NHS usual care. Results: Over the 8-year period 1999-2006, a total of 172 cumulative LC deaths were observed in the invitation-to-screen cohort; 210 were expected based on the reference population. Each year in the invited cohort the observed LC deaths were fewer than expected. The cumulative LC SMR was 0.82 (95%CI, 0.67-0.99; p = 0.048), suggesting that LC mortality was reduced by 18% with CXR screening. Conclusion: Implementation of a CXR screening programme at community level was associated with a significant reduction of LC mortality in smokers. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:50 / 54
页数:5
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