Screening for lung cancer: can it be cost-effective?

Last year, the Lancet reported on a study concerning a particular, avant-garde regimen of CT-based screening for lung cancer, showing its great superiority relative to the corresponding regimen based on traditional radiography (Lancet 1999;354:99-105). That report was met with great interest in the media, worldwide. It thereby also led to substantial public demand for the state-of-the-art screening, in the United States especially. I here argue that, despite the prevailing official recommendations against any and all screening for lung cancer in the United States and Canada, it actually already is knowable that modern screening, with suitable specifications of both the screening itself and its recipient, not only is effective but can be effective enough to amply justify its cost. It thus is time for authorities to formulate, ever more inclusively, those cost-justifying specifications--and to promote research providing for further expansions of and innovations in them. American authorities, however, have not reacted this way to the new situation and, I dare say, they have been tenaciously irrational (and thereby irresponsible) in their underlying ideas about the nature of the proper knowledge-base for screening practice and of the research serving to advance this. It remains to be seen how timely, and how compellingly rational, the Canadian official reactions will be; and this too matters greatly, as countless lives hang in the balance, within Canada and, especially, in the world at large. Ex Canada lux?