# Screening by chest radiograph and lung cancer mortality: the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized trial

Source: https://onco.cc/key-papers/paper-plco-chest-radiograph-lung-cancer-mortality-jama-2011/  
OnCo record `paper-plco-chest-radiograph-lung-cancer-mortality-jama-2011` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

154,901 people were randomised to yearly chest X-rays or usual care. After 13 years the number who died of lung cancer was the same in both groups. The test that had been used for decades did not work.

## Summary

The lung arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, reported by Oken, Hocking, Kvale and colleagues: 154,901 participants aged 55 to 74 randomised between November 1993 and July 2001 at ten United States centres, 77,445 offered annual posteroanterior chest radiographs for four years and 77,456 to usual care, followed for up to 13 years.

PLCO is the control that makes NLST interpretable. NLST compared low-dose computed tomography against chest radiography rather than against nothing, and the reason that was an acceptable design is that PLCO had already established radiography to be no better than usual care.

## Fields

- Kind: Key paper
- Last checked: 2026-09-25
- Tags: lung-evidence
- Journal: JAMA
- Year: 2011
- DOI: 10.1001/jama.2011.1591
- Authors: Oken MM, Hocking WG, Kvale PA, et al.
- Findings: Cumulative lung cancer incidence through 13 years was 20.1 per 10,000 person-years in the screened group and 19.2 in usual care (rate ratio 1.05, 95 percent confidence interval 0.98 to 1.12).; 1,213 lung cancer deaths in the intervention group against 1,230 in usual care through 13 years (mortality rate ratio 0.99, 0.87 to 1.22).; Stage and histology were similar between the two groups.; Screening adherence was 86.6 percent at baseline and 79 to 84 percent in years 1 to 3; screening use in the usual care group was 11 percent.; In the subset eligible for NLST, over the same 6-year follow-up, the mortality rate ratio was 0.94 (0.81 to 1.10).
- What it means: A negative screening trial that saved a generation from a useless test, and the reason low-dose computed tomography had to be proved separately rather than assumed to work because it saw more.
- Caveats: Four annual screens only; a longer programme was not tested.; 11 percent contamination in the usual care group would dilute any true effect.; Chest radiography as practised in the 1990s; it says nothing about the modern reads of those films by machine.

## Sources

- JAMA 2011: https://doi.org/10.1001/jama.2011.1591
- PubMed: https://pubmed.ncbi.nlm.nih.gov/22031728/
- ClinicalTrials.gov NCT00002540: https://clinicaltrials.gov/study/NCT00002540

## Connected records

- key papers: [NELSON: volume-based CT screening reduces lung cancer deaths with fewer false alarms](https://onco.cc/key-papers/paper-nelson-nejm-2020/), [NLST: yearly low-dose CT scans cut lung cancer deaths in heavy smokers](https://onco.cc/key-papers/paper-nlst-nejm-2011/), [PLCO: mortality results from a randomised prostate cancer screening trial](https://onco.cc/key-papers/paper-andriole-plco-prostate-screening-nejm-2009/)
- roadmaps: [Early detection roadmap: organ screening → blood tests for many cancers](https://onco.cc/roadmaps/early-detection-roadmap/), [Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch](https://onco.cc/roadmaps/lung-cancer-evidence-roadmap/)
- cancers: [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- technologies: [Low-dose CT lung screening](https://onco.cc/technologies/low-dose-ct-screening/)
- institutions: [National Cancer Institute (NIH)](https://onco.cc/institutions/nci/)
- terms: [Overdiagnosis](https://onco.cc/terms/overdiagnosis/)
- bottlenecks: [Failures are hidden](https://onco.cc/bottlenecks/b-negative-results/), [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- journals: [JAMA](https://onco.cc/journals/jama/)

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