Lung cancer is the leading cause of cancer-related death in the United States. Since publication of results from the National Lung Screening Trial, several professional organizations, including the US Preventive Services Task Force, have published guidelines recommending low-dose computed tomography for screening in asymptomatic, high-risk individuals. The benefits of screening include detection of cancer at an early stage when a definitive cure is possible, but the risks include overdiagnosis, false-positive results, psychological distress, and radiation exposure. The current review covers the scope of low-dose computed tomography screening, potential risks, costs, and future directions in the efforts for early detection of lung cancer. Cancer 2015;121:1347-56. V C 2015 American Cancer Society.KEYWORDS: cancer screening, lung neoplasms, risk assessment, early detection.
INTRODUCTIONLung cancer (LC) is the second most common cancer among both men and women in the United States and accounts for more deaths than any other cancer. 1 The 5-year survival rate for LC remains low at 16.8% and is <5% for patients with metastatic disesae. 2 The utility of sputum cytology and chest radiographs alone and in combination has been extensively studied and has not exhibited any benefit as a screening tool. 3,4 Several single-arm trials have suggested that screening with computed tomography (CT) may be of benefit 5 ; however, it was not until the publication of the National Lung Screening Trial (NLST) in 2010 that strong evidence was available in support of LC screening. 6 The results of the NLST lead to several professional societies supporting LC screening for individuals at high risk. 6,7 The US Preventive Services Task Force (USPSTF) guidelines gave a Grade B recommendation for LC screening using annual low-dose CT (LDCT) in high-risk individuals. 8 Since publication of the NLST, additional studies have been completed that further refine an individual's risk, thereby identifying the best candidates for screening. 9,10 This review focuses on current recommendations for LC screening, including risks, benefits, costs, and future directions in the efforts for early detection.