Lung cancer screening: is it time for a change in policy?

Two recent studies of computed tomography (CT) as a screening test for lung cancer have heightened debate about this topic. Although the International Early Lung Cancer Action Program investigators (N Engl J Med 2006; 355:1763-1771) concluded that annual CT screening can detect lung cancer that is curable, Bach et al (JAMA 2007; 297:953-961) concluded that it may not meaningfully reduce the risk of advanced lung cancer or death from lung cancer. We feel that questions remain about the degree of reduction in lung cancer-specific mortality, the potential morbidity caused by screening, the appropriate group to screen, and the cost-effectiveness of screening. These questions warrant further study prior to accepting CT screening as the standard of care. Hopefully, much of this knowledge will be gained when the results of ongoing controlled studies are available.