Bach Peter B, Silvestri Gerard A, Hanger Morgan, Jett James R
Memorial Sloan-Kettering Cancer Center, 307 East 63rd St, Third Floor, New York, NY 10021, USA.
Chest. 2007 Sep;132(3 Suppl):69S-77S. doi: 10.1378/chest.07-1349.
Lung cancer typically exhibits symptoms only after the disease has spread, making cure unlikely. Because early-stage disease can be successfully treated, a screening technique that can detect lung cancer before it has spread might be useful in decreasing lung cancer mortality.
In this article, we review the evidence for and against screening for lung cancer with low-dose CT and offer recommendations regarding its usefulness for asymptomatic patients with no history of cancer.
Studies of lung cancer screening with chest radiograph and sputum cytology have failed to demonstrate that screening lowers lung cancer mortality rates. Published studies of newer screening technologies such as low-dose CT and "biomarker" screening report primarily on lung cancer detection rates and do not present sufficient data to determine whether the newer technologies will benefit or harm. Although researchers are conducting randomized trials of low-dose CT, results will not be available for several years. In the meantime, cost-effectiveness analyses and studies of nodule growth are considering practical questions but producing inconsistent findings.
For high-risk populations, no screening modality has been shown to alter mortality outcomes. We recommend that individuals undergo screening only when it is administered as a component of a well-designed clinical trial with appropriate human subjects' protections.
肺癌通常在疾病扩散后才出现症状，使得治愈变得不太可能。由于早期疾病能够得到成功治疗，一种能够在肺癌扩散前检测出它的筛查技术可能有助于降低肺癌死亡率。
在本文中，我们回顾了支持和反对使用低剂量CT筛查肺癌的证据，并就其对无癌症病史的无症状患者的有用性提供建议。
胸部X光片和痰细胞学检查用于肺癌筛查的研究未能证明筛查能降低肺癌死亡率。关于低剂量CT和“生物标志物”筛查等更新的筛查技术的已发表研究主要报告肺癌检测率，并未提供足够数据来确定这些新技术是有益还是有害。尽管研究人员正在进行低剂量CT的随机试验，但结果在数年内都无法获得。与此同时，成本效益分析和结节生长研究正在考虑实际问题，但得出的结果并不一致。
对于高危人群，尚无筛查方式被证明能改变死亡率结果。我们建议，只有当筛查作为一项设计良好且有适当人体受试者保护措施的临床试验的一部分进行时，个体才应接受筛查。
