Lung Cancer Screening: Evidence, Recommendations, and Controversies

Abstract

Lung cancer causes the most cancer-related deaths worldwide. The incidence of lung cancer increases with age, and the most important risk factor is smoking. Smoking prevention and cessation programs have decreased the number of lung cancer cases. The overall prognosis of lung cancer remains poor, despite advances in treatment. The purpose of lung cancer screening is detecting malignancy at an earlier and curable stage. The National Lung Screening Trial demonstrated that early detection of lung cancer with low-dose computed tomography (LDCT) decreases mortality compared with screening by chest radiography. In the United States, several organizations published guidelines, recommending implementation of lung cancer screening for high-risk patients. However, some important questions regarding LDCT screening have so far been unanswered. The awaited results of the European trials and pooling of data will be crucial in establishing recommendations regarding clinical implementation of lung cancer screening in asymptomatic high-risk persons. This review presents an overview of current evidence, recommendations, and controversies concerning lung cancer screening.