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A Critical Analysis of Nine Premises Underlying Lung Cancer Screening

Reich, Jerome M. MD, FCCP

Clinical Pulmonary Medicine:
doi: 10.1097/01.cpm.0000252757.25801.e8
Topics in Pulmonary Medicine

The hypothesis that lung cancer mortality can be diminished by radiographic screening is founded on several implicit assumptions. Some are debated, eg, that overdiagnosis is so infrequent that its effect can be discounted and screening can be cost-effective. Others, although unproven, appear axiomatic, eg, that the incidence of lung cancer is fixed except for minor secular changes; that increased survival of screen identified early lung cancer will necessarily reduce mortality; and that increased identification of surgically curable lung cancers will achieve a reciprocal reduction in the number of advanced and surgically incurable lung cancers. Some premises appear to be not only self-evident, but tautological, eg, that the prognosis of stage I lung cancer equals the prognosis of stage I lung cancer. Each of these implicit premises, and more, are open to question; they are the subject of this review.

In Brief

The potential efficacy of radiographic screening for lung cancer relies on a number of implicit assumptions, for example, that overdiagnosis is infrequent, that CT screening can be cost-effective, and that an increase in the proportion of early stage disease discovered by screening (associated with a high long-term survival) will reduce lung cancer mortality. These and other assumptions, the truths of which are essential to screening success, are open to question and are the subject of this review.

Author Information

From Earl A. Chiles Research Institute, Portland Providence Medical Center, Portland, OR.

Address correspondence to: Jerome M. Reich, MD, 7400 SW Barnes Road, A 622, Portland, OR 97225. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.