Lung cancer screening and the surgical oncologist: the controversy

Although screening for lung cancer is not currently recommended, randomized trials consistently demonstrate that chest x-ray screening is associated with significant advantages in stage distribution, resectability, and long-term survival. Because these advantages have not been accompanied by a reduction in lung cancer mortalities a because an excess number of lung cancers were detected in experimental populations in two studies, it has been suggested that screening leads to the detection of clinically unimportant lung cancers. This hypothesis, known as overdiagnosis, is the only obstacle to the conclusion that chest x-ray screening saves lives. However, abundant evidence convincingly demonstrates that the overdiagnosis hypothesis is myth with regard to chest x-ray screening for lung cancer. With more than one million deaths from lung cancer on a worldwide basis every year, public policy regarding screening for lung cancer is in urgent need of reconsideration.