Current issues in lung cancer screening

Despite improvements in drug therapy, late-stage lung cancer remains routinely incurable. The field of screening for early lung cancer is a challenging, fast-moving, cross-disciplinary area, not without controversy. The ideal situation is one in which we approach screening proactively to allow it to mature as a public health strategy. Spiral CT screening for lung cancer is a new and promising approach to thoracic imaging; it allows for a much more rapid and comprehensive evaluation of a structure than the original CT scan. In this review we will discuss issues inherent to the lung cancer screening process, including the value of smoking cessation strategies, the challenge with the rapid pace of developments in the field, cost concerns, consideration of biases in trial design (overdiagnosis, for example), overtreatment, and radiation risk. We discuss recommendations from several organizations, such as the US Preventive Services Task Force and the American Cancer Society.