Screening for lung cancer: a review

Area of Science:

• Pulmonology
• Oncology
• Radiology

Background:

• Lung cancer screening trials in the late 20th century yielded disappointing results.
• Advancements in low-dose computed tomography (CT) spurred renewed interest in lung cancer screening from the 1990s onwards.
• The body of literature on CT and biomarker screening for lung cancer is rapidly growing.

Purpose of the Study:

• To review the current literature on lung cancer screening utilizing low-dose CT and biomarkers.
• To evaluate the effectiveness and limitations of emerging lung cancer screening technologies.
• To discuss the potential of alternative secondary prevention strategies.

Main Methods:

• Review of existing literature on lung cancer screening.
• Analysis of results from uncontrolled cohort studies of CT screening.
• Discussion of ongoing randomized controlled trials (RCTs) for CT screening.
• Evaluation of emerging screening modalities like biomarkers, autofluorescence bronchoscopy, and chemoprevention.

Main Results:

• Low-dose CT demonstrates superior sensitivity for detecting early-stage lung cancers, especially adenocarcinoma, compared to older chest radiography methods.
• While CT screening shows promising results in cohort studies, its specificity is relatively low, and studies are prone to biases like overdiagnosis.
• Current evidence is insufficient to recommend widespread CT screening in clinical practice.

Conclusions:

• Randomized controlled trials are underway to ascertain if enhanced early detection via CT translates to decreased lung cancer mortality.
• Alternative secondary prevention strategies, including biomarker screening, autofluorescence bronchoscopy, and chemoprevention, show significant future promise.
• Further development and rigorous evaluation in prospective trials are necessary for these alternative approaches.