Context

In the 1970s and 1980s, randomised controlled trials of lung cancer screening with chest radiography and sputum cytology found no lung cancer mortality reduction among high-risk patients.1 Evidence-based guidelines have since recommended against lung cancer screening, although many physicians still endorse screening for high-risk patients, such as chronic smokers.2

The Mayo Lung Study, for example, compared screening with chest radiography and sputum cytology every 4 months to no screening among male, chronically heavy smokers over a 6-year period. Although screening was associated with higher incidence of lung cancer, no benefits in lung cancer mortality were observed, and the extra incidence was most likely attributable to overdiagnosis.

Early trials, however, may have …