Gavelli G, Giampalma E
Institute of Radiology, University of Bologna, S. Orsola Hospital, Italy.
Cancer. 2000 Dec 1;89(11 Suppl):2453-6. doi: 10.1002/1097-0142(20001201)89:11+<2453::aid-cncr21>3.3.co;2-d.
The incidence and mortality rates of lung carcinoma have been increasing during the last years. Despite this, medical public policy holds that chest X-ray screening is ineffective in the early detection of lung carcinoma.
The authors reviewed the most important studies published in the literature regarding the role of chest X-ray screening in the early diagnosis of lung carcinoma in a high risk population. None of the four randomized, controlled trials on lung carcinoma screening conducted in male cigarette smokers demonstrated a reduction in the mortality rate. Accordingly, no organization that formulates screening policy advocates any specific early detection strategies for lung carcinoma.
A careful analysis of randomized, controlled trials showed that there was no improvement in the mortality rate in the screened populations, but there is considerable evidence that chest X-ray screening is associated with earlier detection and improved survival.
In the authors' opinion, the considerable improvements in distribution by disease stage, tumor resectability, and patient survival in the screened groups demonstrate the effectiveness of chest X-ray screening in the early detection of lung carcinoma. The authors conclude that radiographic screening is the only valid method of secondary prevention in cigarette smokers.
在过去几年中，肺癌的发病率和死亡率一直在上升。尽管如此，医学公共政策认为胸部X光筛查在肺癌早期检测中效果不佳。
作者回顾了文献中发表的关于胸部X光筛查在高危人群肺癌早期诊断中作用的最重要研究。在男性吸烟者中进行的四项肺癌筛查随机对照试验均未显示死亡率降低。因此，没有任何制定筛查政策的组织提倡任何特定的肺癌早期检测策略。
对随机对照试验的仔细分析表明，筛查人群的死亡率没有改善，但有大量证据表明胸部X光筛查与早期检测和生存期改善有关。
作者认为，筛查组在疾病分期、肿瘤可切除性和患者生存期分布方面的显著改善证明了胸部X光筛查在肺癌早期检测中的有效性。作者得出结论，影像学筛查是吸烟者二级预防的唯一有效方法。
