© 2000 by Oxford University Press
Journal of the National Cancer Institute, Vol. 92, No. 16, 1308-1316,
August 16, 2000
© 2000 Oxford University Press
Lung Cancer Mortality in the Mayo Lung Project: Impact of Extended Follow-up
Affiliations of authors: P. M. Marcus, R. M. Fagerstrom, P. C. Prorok, Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; E. J. Bergstralh, W. F. Taylor (Biostatistics Section), D. E. Williams, R. Fontana (Division of Pulmonary and Critical Care Medicine), Mayo Clinic, Rochester, MN.
Correspondence to: Pamela M. Marcus, Ph.D., M.S., National Institutes of Health, 6130 Executive Blvd., MSC 7354, Suite 344, Bethesda, MD 20892-7354 (e-mail: pm145q{at}nih.gov).
Background: The Mayo Lung Project (MLP) was a randomized, controlled clinical trial of lung cancer screening that was conducted in 9211 male smokers between 1971 and 1983. The intervention arm was offered chest x-ray and sputum cytology every 4 months for 6 years; the usual-care arm was advised at trial entry to receive the same tests annually. No lung cancer mortality benefit was evident at the end of the study. We have extended follow-up through 1996. Methods: A National Death Index–PLUS search was used to assign vital status and date and cause of death for 6523 participants with unknown information. The median survival for lung cancer patients diagnosed before July 1, 1983, was calculated by use of Kaplan–Meier estimates. Survival curves were compared with the log-rank test. Results: The median follow-up time was 20.5 years. Lung cancer mortality was 4.4 (95% confidence interval [CI] = 3.9–4.9) deaths per 1000 person-years in the intervention arm and 3.9 (95% CI = 3.5–4.4) in the usual-care arm (two-sided P for difference = .09). For participants diagnosed with lung cancer before July 1, 1983, survival was better in the intervention arm (two-sided P = .0039). The median survival for patients with resected early-stage disease was 16.0 years in the intervention arm versus 5.0 years in the usual-care arm. Conclusions: Extended follow-up of MLP participants did not reveal a lung cancer mortality reduction for the intervention arm. Similar mortality but better survival for individuals in the intervention arm indicates that some lesions with limited clinical relevance may have been identified in the intervention arm.
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