Integrating Prevention and Screening for Lung Cancer into Clinical Practice

Abstract

Lung cancer is the leading cause of cancer mortality worldwide. When diagnosed at an early stage, lung cancer 5-year survival is 60–70 %, but when diagnosed clinically, most cancers are advanced and overall 5-year survival is 16 %. Exposure to tobacco smoke is the dominant risk factor, but other environment and host factors are also important. Lung cancer prevention and early detection through screening have the potential to reduce lung cancer morbidity and mortality. Risk prediction models can be helpful in defining target populations for both prevention and screening. Prevention is currently based on avoidance of tobacco use and exposure. There are no established chemoprevention agents for lung cancer, but this remains an area of active investigation. The National Lung Screening Trial (NLST) demonstrated for the first time that screening with low-dose computed tomography (LDCT) reduces lung cancer mortality among a high-risk population. Efforts to better define the optimal approach to screening and the development of lung cancer screening guidelines are now underway. Discovery of biomarkers capable of detecting lung cancer at an early stage is another area of great promise. The combination of LDCT and biomarkers in the future should help improve the accuracy and clinical utility of screening programs. All screening programs should incorporate access to tobacco cessation resources.