Lung cancer: the American view

Bronchogenic carcinoma is a major public health problem in the United States, and the leading cancer killer in both men and women. In the early 1970s, the National Cancer Institute (NCI) sponsored multicentre clinical trials to assess the effects of screening by sputum cytology testing and serial chest X-ray examinations on lung cancer mortality in high-risk male smokers. Although more lung cancers were detected, more early stage 1 cancers were resected, and 5 year survival rates were improved in the screened populations than in unscreened controls, there were nearly equal numbers of advanced cancers, and mortality rates were not significantly different. Thus, mass screening to detect early lung cancer has not been pursued as public policy in the United States. In the 1980s, emphasis has shifted to efforts at lung cancer prevention through educational programs aimed at smoking prevention and cessation. In 1984, the NCI adopted a national goal of reducing lung cancer mortality by 50% by the year 2000. Strategy to achieve this is an intensive behaviour modification program to encourage a social climate for smoking abstinence, prevent initiation of smoking among children and adolescents and supply educational materials and encouragement through health care workers and community-based programs.