The pitfalls of lung cancer screening

Lung cancer screening has received extensive attention for a number of years. As yet the goal of such a screening programme, a reduction in lung cancer mortality proven by a large randomised controlled trial, has not been achieved. Instead we are left with a number of unanswered questions and practical problems. In addition to the basic requirements for an effective screening programme, this review will identify the main pitfalls in lung cancer screening, with particular reference to multislice computed tomography. The specific difficulties relating to the identification of unimportant disease, the failure to identify important disease successfully, the consequences of investigating and treating identified disease and the financial costs will all be discussed.

[1]  S Sone,et al.  High-resolution CT analysis of small peripheral lung adenocarcinomas revealed on screening helical CT. , 2001, AJR. American journal of roentgenology.

[2]  P C Goodman,et al.  Correlation of tumor size and survival in patients with stage IA non-small cell lung cancer. , 2000, Chest.

[3]  W. E. Miller,et al.  Lung cancer detected during a screening program using four-month chest radiographs. , 1983, Radiology.

[4]  W. Heindel,et al.  Screening for early lung cancer with low-dose spiral CT: prevalence in 817 asymptomatic smokers. , 2002, Radiology.

[5]  D. Flieder,et al.  Small peripheral glandular lesions detected by screening CT for lung cancer. A diagnostic dilemma for the pathologist. , 2000, Radiologic clinics of North America.

[6]  L. Fajardo,et al.  Screening for preclinical disease: test and disease characteristics. , 2002, AJR. American journal of roentgenology.

[7]  O. Miettinen,et al.  Early Lung Cancer Action Project: overall design and findings from baseline screening , 1999, The Lancet.

[8]  N. Müller,et al.  Lung nodule enhancement at CT: multicenter study. , 2000, Radiology.

[9]  O S Miettinen,et al.  Early Lung Cancer Action Project , 2001, Cancer.

[10]  S. Swensen,et al.  Lung cancer screening with CT: Mayo Clinic experience. , 2003, Radiology.

[11]  F. Fazio,et al.  Early lung-cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results , 2003, The Lancet.

[12]  J. Reich.  Improved survival and higher mortality: the conundrum of lung cancer screening. , 2002, Chest.

[13]  G. Byrnes,et al.  Screening for lung cancer. , 2004, The Cochrane database of systematic reviews.

[14]  Detection of early lung cancer. , 2000, Thorax.

[15]  H. Levin,et al.  Adenocarcinoma of the prostate in cystoprostatectomy specimens removed for bladder cancer , 1989, Cancer.

[16]  D. Mark,et al.  Patient and hospital characteristics related to in-hospital mortality after lung cancer resection. , 1992, Chest.

[17]  L. Tabár,et al.  Quantifying the potential problem of overdiagnosis of ductal carcinoma in situ in breast cancer screening. , 2003, European journal of cancer.

[18]  P C Prorok,et al.  Lung cancer mortality in the Mayo Lung Project: impact of extended follow-up. , 2000, Journal of the National Cancer Institute.

[19]  K. Pantel,et al.  Frequency and prognostic significance of isolated tumour cells in bone marrow of patients with non-small-cell lung cancer without overt metastases , 1996, The Lancet.

[20]  S. Lam,et al.  Lung cancer screening: a different paradigm. , 2003, American journal of respiratory and critical care medicine.

[21]  S. Armato,et al.  Lung cancers missed at low-dose helical CT screening in a general population: comparison of clinical, histopathologic, and imaging findings. , 2002, Radiology.

[22]  S Sone,et al.  Growth rate of small lung cancers detected on mass CT screening. , 2000, The British journal of radiology.

[23]  S. Sone,et al.  Prognostic significance of high-resolution CT findings in small peripheral adenocarcinoma of the lung: a retrospective study on 64 patients. , 2002, Lung cancer.