Controversies and challenges in lung cancer screening

Area of Science:

• Pulmonology
• Radiology
• Health Services Research

Background:

• Two large randomized controlled trials demonstrate mortality benefits of lung cancer screening (LCS) in high-risk populations.
• Updated 2020 United States Preventative Services Task Force guidelines expand eligibility for LCS, increasing the number of high-risk individuals who may benefit.
• Optimizing LCS workflows requires addressing several controversial issues.

Purpose of the Study:

• To identify and discuss controversial issues surrounding lung cancer screening.
• To provide clarity, potential solutions, and future directions for addressing these controversies.
• To support the effective implementation and expansion of lung cancer screening programs.

Main Methods:

• Review and discussion of existing literature and guidelines on lung cancer screening.
• Identification of key controversial areas within LCS.
• Analysis of potential solutions and future research directions.

Main Results:

• Lung cancer screening (LCS) has demonstrated significant mortality benefits.
• Key controversies include high false positive rates with low-dose CT scans.
• Other issues involve over-diagnosis, cost-effectiveness, disparities in screening access for minority populations, and the role of biomarkers.

Conclusions:

• Addressing the identified controversies is crucial for refining lung cancer screening protocols.
• Potential solutions and future research are needed to optimize LCS efficacy, accessibility, and cost-effectiveness.
• Improved understanding and management of LCS controversies will enhance patient outcomes and reduce health disparities.