Lung cancer screening with spiral CT: toward a working strategy

Given that there is no validated test for early lung cancer detection, the current standard approach to lung cancer detection is to wait for signs or symptoms to develop. In that setting, newly detected lung cancer is generally rapidly fatal resulting in over 157,000 deaths annually. Sole dependence on tobacco control is an insufficient public health response to lung cancer, since most newly diagnosed individuals are either former smokers or never smokers. Finding a more effective way to diagnose premetastatic lung cancer would be a crucial step toward an improved lung cancer-related mortality rate. Based on studies of breast cancer screening, we know that achieving optimal benefit from early cancer detection also involves defining the most effective, efficient, and safest approach to the clinical management of screen-identified lung cancer. In this review, we consider how to build on the successes of other cancer screening efforts to detect and manage early lung cancer. This involves outlining the specific elements for lung cancer that could make a screening program safe, affordable, and effective. We also explore the current standards of early lung cancer management and target areas where potential pitfalls and opportunities for improvement exist.