Does the early detection of lung carcinoma improve prognosis? The Turku study

BACKGROUND. The prognosis of lung carcinoma patients is better when the dia gnosis is made early, the disease is localized, and radical surgery is poss ible. Screening for lung carcinoma with mass radiography or sputum cytology should contribute to a more favorable prognosis. To the author's knowledge to dale, large-scale screening studies have shown improved survival but no reduction in mortality. METHODS, The histologic tumor type, disease stage, treatment, and survival rates were studied in 93 men who were found to have lung carcinoma during a single chest X-ray screening of > 33,000 smoking men ages 50-69 years and in 239 men of the same age range whose lung carcinoma was detected either t hrough symptomatic presentation or through chest X-ray obtained for other p urposes. RESULTS. The histologic distribution was similar in the two groups but scre ening detected more early stage tumors that more often were resectable (37% vs. 19%). The 5-year survival rate for the patients detected by screening was 19% and that of the other patients was 10%, with a relative risk 0.65 ( 95% confidence interval, 0.50-0.84). CONCLUSIONS. The results of the current study demonstrate that chest X-ray screening might improve the prognosis of patients with lung carcinoma. Howe ver, these results are subject to many factors that were only partially con trolled and should be interpreted cautiously. Cancer 2000;89:2387-91. (C) 2 000 American Cancer Society.