Screening for lung cancer: an old idea revisited

Standardly diagnosed and treated NSCLC remains a disease of high prevalence and high mortality. Although lessons from the past do not confirm advantage from screening high-risk people, the questions about the design of these studies and the development of newer technologies merit critical re-evaluation of a more refined, targeted, and integrated screening process. Evaluation of further screening efforts should involve selection of appropriate diagnostic tools and definition of the appropriate population, so that the patients who are most likely to benefit from early intervention (those with adequate cardiopulmonary reserve for resection), as well as those with highest risk, are selected. The technologic evolutions in the screening process, in conjunction with refinement in the definition of the appropriate target population through characterization of the molecular biologic markers of lung cancer risk, offer great promise for development of a minimally invasive approach to the identification of early stage disease.