Lung cancer screening-don’t forget the chest radiograph

Abstract

Lung cancer is a major health burden and early detection only bears the possibility of curative treatment. Screening with computed tomography (CT) recently demonstrated a mortality reduction in selected patients and has been incorporated in clinical guidelines. Problems of screening with CT are the excessive number of false positive findings, costs, radiation burden and from a global point of view shortage of CT capacity. In contrast, chest radiography could be an ideal screening tool in the early detection of lung cancer. It is widely available, easy to perform, cheap, the radiation burden is negligible and there is only a low rate of false positive findings. Large randomized controlled trials could not show a mortality reduction, but different large population-based cohort studies have shown a lung cancer mortality reduction. It has been argued that community-based cohort studies are more closely reflecting the "real world" of everyday medicine. Radiologists should be aware of the found mortality reduction and realize that early detection of lung cancer is possible when reading their daily chest radiographs. Offering a chest radiograph in selected scenarios for the early detection of lung cancer is therefore still justified.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Lung cancer; Screening; Mortality; Chest radiographCore tip: Screening with computed tomography (CT) recently demonstrated a mortality reduction in selected patients with lung cancer, but there are several shortcomings of screening with CT (false positive findings, high costs, radiation burden, shortage of capacity). In contrast, chest radiography could be an ideal screening tool in the early detection of lung cancer. It is widely available, its radiation burden is negligible and there is only a low rate of false positive findings. In contrast to randomized controlled trials different large population-based cohort studies have shown a lung cancer mortality reduction using chest radiography. In conclusion, early detection of lung cancer is also possible with chest radiography.Gossner J. Lung cancer screening-don't forget the chest radiograph. World J Radiol 2014; 6(4): 116-118 Available from: URL:

Performance of a Deep Learning Algorithm Compared with Radiologic Interpretation for Lung Cancer Detection on Chest Radiographs in a Health Screening Population

“…Thus, it is controversial whether lung cancer screening should be performed using chest radiography. Nonetheless, chest radiography is widely used as an initial screening tool for several important thoracic diseases, including lung cancer, in the general population thanks to its low cost, easy accessibility, negligible radiation dose, and reasonable diagnostic capability (10)(11)(12). However, the low sensitivity of lung cancer detection, substantial inter-and intrareader variability, and vulnerability to observer error remain persistent weaknesses of chest radiography as a screening tool (13)(14)(15).…”

Is chest X-ray screening for lung cancer in smokers cost-effective? Evidence from a population-based study in Italy

“…It is widely available, relatively inexpensive, and non-invasive. Additionally, CXR screening causes negligible overdiagnosis of LC [ 21 ] and a low rate of false-positive results [ 22 , 26 ].…”

“…CXR as a LC screening tool is definitely less sensitive than chest CT [ 19 ], however it is more specific [ 20 ] and there are several clinical reasons why the cost-effectiveness of screening with chest radiograph may be worth investigating. With CXR screening there is not only a lower probability of false positive tests, but also less LC overdiagnosis and lower radiation doses than with CT screening [ 21 , 22 ]. Moreover, from an economic perspective CXR is a relatively inexpensive and broadly accessible exam, two highly favorable features in a screening tool.…”

Role of chest radiographs in early lung cancer detection

“…They have a low cost, can be used conveniently at bedside, have low radiation exposure, and provide an abundance of information that is useful in follow-up studies. Although survival benefits are much higher with LDCT and the advantages of screening with CXRs are still being investigated (8,9,13-16), the possible 19 [14][15][16][17][18][19][20][21][22][23][24][25][26][27] 19 [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] 17 [13][14][15][16][17][18][19][20][21][22] 0 merit of CXRs as a screening tool cannot be ignored. In 2015, 24,267 patients in the Republic of Korea were diagnosed with lung cancer.…”