Screening for lung cancer: time for large-scale screening by chest computed tomography

Area of Science:

• Oncology
• Radiology
• Public Health

Background:

• Lung cancer is a leading cause of cancer death globally, with age and smoking as primary risk factors.
• Early-stage surgical treatment improves survival, but traditional screening methods like chest radiography and sputum cytology have not reduced mortality.
• Low-dose computed tomography (CT) shows promise for early detection in high-risk groups.

Purpose of the Study:

• To evaluate the effectiveness of low-dose CT screening for lung cancer mortality reduction.
• To discuss the implications of new guidelines for lung cancer screening.
• To highlight the challenges and future directions in lung cancer screening.

Main Methods:

• Review of screening program outcomes, including chest radiography, sputum cytology, and low-dose CT.
• Analysis of results from randomized control trials, notably the National Lung Screening Trial (NLST).
• Examination of new guidelines for lung cancer screening based on eligible criteria.

Main Results:

• Low-dose CT screening demonstrated high rates of early-stage lung cancer detection in high-risk populations.
• The National Lung Screening Trial (NLST) showed a 20% relative reduction in lung cancer mortality and a 6.7% reduction in overall mortality.
• Screening revealed a high rate of false-positive lesions, necessitating further diagnostic evaluations.

Conclusions:

• Lung cancer screening with low-dose CT is entering a new era, offering mortality benefits but also presenting challenges like false positives.
• New guidelines recommend screening in specialized centers with multidisciplinary teams and mandatory pre-screening patient discussions.
• Further research is needed to address remaining questions and optimize lung cancer screening strategies.