1. Thorax. 2017 Sep;72(9):825-831. doi: 10.1136/thoraxjnl-2016-209825. Epub 2017 Apr

Mortality, survival and incidence rates in the ITALUNG randomised lung cancer
screening trial.

Paci E(1), Puliti D(1), Lopes Pegna A(2), Carrozzi L(3), Picozzi G(4), Falaschi
F(5), Pistelli F(3), Aquilini F(3), Ocello C(1), Zappa M(1), Carozzi FM(6),
Mascalchi M(7); the ITALUNG Working Group.

Collaborators: Paci E, Puliti D, Zappa M, Ocello C, Manneschi G, Visioli C,
Cordopatri G, Giusti F, Esposito I, Pegna AL, Bianchi R, Ronchi C, Carrozzi L,
Aquilini F, Cini S, De Santis M, Pistelli F, Baliva F, Chella A, Tavanti L,
Grazzini M, Innocenti F, Natali I, Mascalchi M, Bartolucci M, Crisci E, De
Francisci A, Falchini M, Gabbrielli S, Roselli G, Masi A, Falaschi F, Battola L, 
De Liperi A, Spinelli C, Vannucchi L, Petruzzelli A, Gadda D, Neri AT, Niccolai
F, Vaggelli L, Vella A, Carozzi FM, Maddau C, Bisanzi S, Picozzi G, Janni A,
Mussi A, Lucchi M, Comin C, Fontanini G, Tognetti AR, Iacuzio L, Caldarella A,
Barchielli A, Goldoni CA.

Author information: 
(1)Clinical Epidemiology Unit, ISPO-Cancer Research and Prevention Institute,
Florence, Italy.
(2)Pneumonology Department, Careggi Hospital, Florence, Italy.
(3)Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of
Pisa, Pisa, Italy.
(4)Radiodiagnostic Unit, ISPO-Cancer Research and Prevention Institute, Florence,
(5)2nd Radiology Unit, University Hospital of Pisa, Pisa, Italy.
(6)Prevention Laboratory Unit, ISPO-Cancer Research and Prevention Institute,
Florence, Italy.
(7)Radiodiagnostic Section, Department of Experimental and Clinical Biomedical
Sciences, University of Florence, Florence, Italy.

Comment in
    Thorax. 2017 Sep;72 (9):778-779.

BACKGROUND: ITALUNG is contributing to the European evaluation of low-dose CT
(LDCT) screening for lung cancer (LC).
METHODS: Eligible subjects aged 55-69 years, smokers or ex-smokers (at least 20
pack-years in the last 10 years), were randomised to receive an annual invitation
for LDCT screening for 4 years (active group) or to usual care (control group).
All participants were followed up for vital status and cause of death (at the end
of 2014) and LC incidence (at the end of 2013). Pathological and clinical
information was collected from the Tuscan Cancer Registry data.
RESULTS: 1613 subjects were randomly assigned to the active group and 1593 to the
control group. At the end of the follow-up period 67 LC cases were diagnosed in
the active group and 71 in the control group (rate ratio (RR)=0.93; 95% CI 0.67
to 1.30). A greater proportion of stage I LC was observed in the active group
(36% vs 11%, p<0.001). Non-significant reductions of 17% (RR=0.83; 95% CI 0.67 to
1.03) for overall mortality and 30% (RR=0.70; 95% CI 0.47 to 1.03) for
LC-specific mortality were estimated.
CONCLUSIONS: Despite the lack of statistical significance, the ITALUNG trial
outcomes suggest that LDCT screening could reduce LC and overall mortality.
Moreover, the comparison of the number of LC cases diagnosed in the two groups
does not show overdiagnosis after an adequate follow-up period. A pooled analysis
of all European screening trials is advocated to assess the benefit-to-harm ratio
of LDCT screening and its implementation in public health settings.

Published by the BMJ Publishing Group Limited. For permission to use (where not
already granted under a licence) please go to

DOI: 10.1136/thoraxjnl-2016-209825 
PMID: 28377492  [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.