Lung cancer screening - are we there yet?

Background: Lung cancer is the most lethal cancer and most cases are the result of cigarette smoking. Although a high risk target population for screening can be defined, and although early stage lung cancer has a much better prognosis than advanced disease, there is still no clear evidence that lung cancer screening decreases mortality. Accordingly, current guidelines suggest that there is no evidence to support routine screening. Although randomized studies in the 1970's which used chest x-ray and sputum for screening were clearly negative in the last 20 years more sensitive screening tools such as chest computed tomography have revolutionized the field. However, randomized controlled trials of computed tomography have only recently been launched. Aims of this review: Our objectives are to provide the reader with the rationale for screening for lung cancer, to review the older screening studies and their limitations, and to summarize the current knowledge and ongoing trials of lung cancer screening. Literature search: A literature search using Medline was conducted from 1966 onwards searching for articles with relevant key words such as lung cancer screening chest X - ray low dose computerized tomography cancer screening guideline. When appropriate additional references were found from the bibliographies of identified papers of interest. Conclusions: Recent uncontrolled multicenter studies of chest computed tomography scans show encouraging results. However, until data from, large properly designed and appropriately analyzed randomized controlled trials which may overcome research biases is available, the benefit of lung cancer screening, if any is still unknown. (C) 2009 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.