Using Annual Chest X-Rays to Screen for Lung Cancer Doesn’t Reduce Mortality

Using chest radiography to screen for lung cancer does not reduce lung cancer mortality compared with usual care, a large clinical trial has found. (Image: Maria Toutoudaki/

Patients who received annual chest radiography for 4 years were no less likely to die of lung cancer than those who received usual care, according to findings from a large randomized trial published online today in JAMA. In an accompanying editorial, Harold C. Sox, MD, of the Dartmouth Medical School in West Lebanon, New Hampshire, said the study may put to rest questions about the value of such screening.

For more than 40 years, a debate has raged about whether chest radiography could help reduce lung cancer mortality by allowing earlier detection and treatment. Although several randomized trials, including some conducted in the 1970s and 1980s, found no benefit, because the studies were small or had other limitations, the question has lingered.

The new findings are from the Prostate, Lung, Colorectal, and Ovarian Cancer (PLCO) Screening Trial, which enrolled 154 901 individuals who were randomly assigned to receive either annual screening for lung cancer with radiography for 4 years or usual care and were subsequently followed up for more than a decade. The multi-institution team of researchers found no significant difference between the 2 groups in the rates of either lung cancer detection or lung cancer mortality. In addition, among those who developed lung cancer, the disease was not detected at an earlier stage in participants who had received screening compared with participants who had received only usual care.

“The [study] result provides convincing evidence that lung cancer screening with chest radiography is not effective,” Sox said.

Additionally, the study’s findings may aid the interpretation of results from another large trial, the National Lung Screening Trial (NLST), which found that low-dose spiral computed tomography (CT) screening for lung cancer reduced mortality from the disease by 20% compared with screening using chest radiography. However, the NLST didn’t examine whether such screening was better than usual care. The PLCO trial’s finding that usual care and chest radiography have equivalent effects on lung cancer mortality suggests that CT is also likely better than usual care, both Sox and PLCO trial investigators concluded, although they noted that there are limitations to making such indirect assessments.

Categories: Computed Tomography, Evidence-Based Medicine, Lung Cancer, Radiography