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Lung cancer screening: has there been any progress? Computed tomography and autofluorescence bronchoscopy

Lee, Pyng; Sutedja, Tom G

Current Opinion in Pulmonary Medicine: July 2007 - Volume 13 - Issue 4 - p 243–248
doi: 10.1097/MCP.0b013e32818b27d3
Neoplasms of the lung

Purpose of review Advances in imaging technologies are currently being explored in the attempt to reduce lung cancer morbidity and mortality by achieving stage shift. We reviewed recent important publications on lung cancer screening.

Recent findings Autofluorescence bronchoscopy has established its important role in the intervention of early central airway lesions. Multidetector computed tomography (CT) and CT–positron emission tomography may facilitate diagnosis of early parenchymal lung lesions. Practical implications of screening are reaching far beyond early diagnostic efforts per se as lead-time, length-time, overdiagnosis biases combined with low specificity of screening tests undermine its cost-effectiveness in the era of healthcare budget constraints.

Summary Advanced imaging technologies may allow early detection and prudent intervention in some individuals that harbour asymptomatic early lung cancer, but disproportional expenses may be required to sieve out many more individuals at risk to attain stage shift. Confounding co-morbidities and practical hurdles may reduce screening's efficacy as it is plausible that for the majority of smokers, lung cancer may not be the ultimate cause of suffering since 90% of them will not develop lung cancer. This fact remains true despite increased use of noninvasive and minimally invasive technologies for the maximum preservation of quality of life irrespective of whether early intervention is a success or failure.

Department of Pulmonary Medicine, Vrije Universiteit Academic Hospital, Amsterdam, The Netherlands

Correspondence to G. Sutedja, MD, PhD, Dept. of Pulmonary Medicine, VUMC Amsterdam, PO Box 7057, 1007MB, The Netherlands Tel: +31 20 444 4782; fax: +31 20 444 4328; e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.