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Earlier trials of sputum cytology, chest radiography (CXR), or both for lung cancer screening showed no benefit, but the trials were small and methodologically weak. In this large multisite U.S. study of CXR screening compared with usual care, nearly 155,000 people (age range, 55–74; 45% never-smokers) were randomized to annual CXR for 4 years or usual care. Participants were recruited broadly, beginning about 18 years ago, and essentially no exclusion criteria, except prior cancer, were applied. Adherence in the intervention group was about 80% to 85%; about 11% of control participants underwent CXR at least once.
Cumulative lung cancer incidence rates were roughly 20 per 10,000 person-years through the 13 years of follow-up and ranged from…