Cigarette-smoking males (6,364), aged 40-64, were randomized into an intervention group which received 6-monthly screening by chest X-ray and sputum cytology, and a control group which received no asymptomatic investigation. After 3 years, both groups entered a follow-up period during which they received annual chest X-rays. Lung cancer cases detected by screening were identified at an earlier stage, more often resectable, and had a significantly better survival than "interval" cases diagnosed mainly because of symptoms. Comparison of the 2 groups showed a higher incidence of lung cancer in the intervention group, despite the follow-up period when both groups received annual examinations. There was no significant difference in mortality between the 2 groups.

A randomized prospective study of lung cancer detection was begun in 1976 to evaluate semiannual screening by radiologic and sputum cytologic study in comparison to screening at a 3-year interval, and to no screening. In a high-risk population of 6364 men (aged 40 to 64 years), the initial prevalence of lung cancer was 0.28% (18 cases), the annual incidence was 0.35% per year (66 cases during 3 years), the proportion of Stage I cases was 31% (26/84), and Stage I1 was 17% (14/84), "curative" resections were 27% (23/84), and 5-year survival was 23% (19/84). The study confirmed the ability of radiologic screening to detect lung cancer a t an earlier stage when treatment by resection can be accomplished. The fate of a high-risk population submitted to screening was better than that of a population with no screening where lung cancer was discovered by symptoms, accidental x-rays, or a t autopsy. A matter of lesser importance was the frequency of screening. The absolute numbers of 5-year survivors detected by screening were practically the same for either compared screening frequency.

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who underwent lung scintigraphy for suspected pulmonary embolism and for whom the pul monary embolism was proven at autopsy. MATERIALS AND METHODS. Weperformed a longitudinal follow-upstudyof 1210consecutive patients who underwent scintigraphic imaging for suspected pulmonary embo lism. Patients for whom pulmonary embolism was proven at autopsy within 30 days of lung scintigraphy were studied. Diagnostic testing and risk factors were compared in patients with and without an antemortem diagnosis of pulmonary embolism. RESULTS. The antemortem diagnosis wasmadein fourof eightpatients with autopsyproven pulmonary embolism, yielding a sensitivity of 0.5 (95% confidence interval, 0.16-0.84). The diagnosis was made by high-probability lung scintigraphy in two patients, by pulmonary arteriography in one patient, and by lower extremity venous sonography in another patient. The imaging investigation for suspected pulmonary embolism included only lung scintigra phy in four patients in whom the antemortem diagnosis was incorrect: two with low-probabil ity scintigraphy and two with intermediate-probability scintigraphy. Risk factors were similar for patients with and without pulmonary embolism. CONCLUSION. In thiscohortstudyof patients suspected of havingpulmonary embolism, the antemortem diagnosis was not made in 50% of patients in whom pulmonary embo lism was later proven at autopsy. Underuse of diagnostic testing may have been to blame. We therefore believe that further study is needed to help identify patients with suspected pulmo nary embolism who may benefit from additional diagnostic testing after low-or intermediate probability lung scintigraphy.Lara Patriquin' has been to identify pulmonary embolism pa tients who were autopsied and then to deter mine the clinical characteristics relating to the diagnosis of thromboembolic disease.The diagnostic approaches for suspected pulmonary embolism have broadened to in dude diagnostic testing of the lower extremity veins in addition to pulmonary arteriography [5,6]. Although pulmonary angiography re mains the gold standard for diagnosing pul Autopsy studies have looked at the out come, death from pulmonary embolism, and then determined possible clinical indicators that might have been useful in making the an temortem diagnosis [2,3]. To our knowledge, no studies have looked at autopsy-proven pul monary embolism as the outcome for patients who had been examined for suspected pulmo nary embolism. We therefore longitudinally followed up a cohort of consecutive patients who had been examined for suspected pul monary embolism with ventilationâ€"perfusion scintigraphy. Materials and MethodsWe studied 1210consecutivepatientsseen at the Brigham and Women's Hospital in a 22-month in tervalwho underwentventilationâ€"perfusion scintig

BackgroundAdherence to a traditional Mediterranean diet has been associated with lower mortality and cardiovascular disease risk. The relative importance of diet compared to other lifestyle factors and effects of dietary patterns over time remains unknown.MethodsWe used the parametric G-formula to account for time-dependent confounding, in order to assess the relative importance of diet compared to other lifestyle factors and effects of dietary patterns over time. We included healthy Melbourne Collaborative Cohort Study participants attending a visit during 1995–1999. Questionnaires assessed diet and physical activity at each of three study waves. Deaths were identified by linkage to national registries. We estimated mortality risk over approximately 14 years (1995–2011).ResultsOf 22,213 participants, 2163 (9.7%) died during 13.6 years median follow-up. Sustained high physical activity and adherence to a Mediterranean-style diet resulted in an estimated reduction in all-cause mortality of 1.82 per 100 people (95% confidence interval (CI): 0.03, 3.6). The population attributable fraction was 13% (95% CI: 4, 23%) for sustained high physical activity, 7% (95% CI: − 3, 17%) for sustained adherence to a Mediterranean-style diet and 18% (95% CI: 0, 36%) for their combination.ConclusionsA small reduction in mortality may be achieved by sustained elevated physical activity levels in healthy middle-aged adults, but there may be comparatively little gain from increasing adherence to a Mediterranean-style diet.