Screening for lung cancer: a review.

PURPOSE OF REVIEW

After the disappointing results of lung cancer screening trials conducted in the 1960s to the 1980s, a renewed interest in lung cancer screening emerged in the 1990s with the development of new technologies such as low-dose spiral CT. The literature regarding screening with biomarkers and CT continues to expand rapidly.

RECENT FINDINGS

Although the specificity of CT screening is relatively poor, the sensitivity for the detection of early-stage cancers, particularly adenocarcinoma, is considerably superior to that of chest radiography used in older screening trials. The results of uncontrolled cohort studies of CT screening are promising, but such studies are susceptible to screening biases such as overdiagnosis.

SUMMARY

There is insufficient evidence to support widespread screening in current practice. However, randomized controlled trials are now being conducted to determine whether improved detection by CT will translate into reduced lung cancer mortality. Alternative approaches to secondary prevention such as screening with biomarkers, autofluorescence bronchoscopy, and chemoprevention hold great promise for the future but await further development and evaluation in prospective trials.