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Screening for lung cancer

Prosch, Helmuta; Schaefer-Prokop, Corneliab

doi: 10.1097/CCO.0000000000000055
LUNG AND MEDIASTINUM: Edited by Robert Pirker

Purpose of review: The purpose of this review is to provide an update on the current data about low-dose computed tomography (LD-CT) lung cancer screening.

Recent findings: The National Lung Screening Trial (NLST) was the first study that provided statistical evidence that LD-CT screening for lung cancer significantly reduces lung cancer mortality by 20%. Three statistically underpowered European trials could not confirm the positive effect of LD-CT screening on lung cancer mortality. Major obstacles in lung cancer screening are overdiagnosis and the large number of false-positive results. In the NLST, more than 24% of the screens were positive, most of which (96.4%) proved to be benign in nature. Optimized protocols for the workup of detected nodules may help to reduce the number of false-positive screens.

Summary: Currently, the NLST is the only sufficiently powered trial to report a lower mortality rate with LD-CT screening. Long-term follow-up data are still anticipated on the European screening trials. Furthermore, data on the extent of the potential dangers of LD-CT screening, such as overdiagnosis, false-positive results, and the effect of cumulative radiation dose, have yet to be investigated thoroughly.

aDepartment of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria

bRadiologie, Meander Medical Center, Ameersfoort und Radboud Universitaet, Nijmegen, the Netherlands

Correspondence to Assistant Professor Helmut Prosch, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. Tel: +43 1 40400 4818; e-mail: helmut.prosch@meduniwien.ac.at

© 2014 Lippincott Williams & Wilkins, Inc.