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Randomized Controlled Trial
. 2019 Jul 1;30(7):1162-1169.
doi: 10.1093/annonc/mdz117.

Prolonged lung cancer screening reduced 10-year mortality in the MILD trial: new confirmation of lung cancer screening efficacy

U Pastorino  1 , M Silva  2 , S Sestini  3 , F Sabia  3 , M Boeri  4 , A Cantarutti  5 , N Sverzellati  6 , G Sozzi  4 , G Corrao  5 , A Marchianò  7
Affiliations
Randomized Controlled Trial

Prolonged lung cancer screening reduced 10-year mortality in the MILD trial: new confirmation of lung cancer screening efficacy

U Pastorino et al. Ann Oncol. .

Erratum in

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.

Keywords: early detection; low-dose computed tomography; lung cancer; mortality; overdiagnosis; screening.

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Figures

Figure 1.
Figure 1.
Cumulative overall mortality and lung cancer mortality, by arm over 10 years of follow-up.
Figure 2.
Figure 2.
Landmark analysis of cumulative overall mortality and lung cancer mortality, by arm beyond 5 years.
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