Klinik für Pneumologie Universitätsspital Zürich Rämistrasse 100 CH-8091 Zürich Switzerland.
Swiss Med Wkly. 2011 Apr 13;141:w13185. doi: 10.4414/smw.2011.13185. eCollection 2011.
Almost three decades ago several controlled studies failed to show that lung cancer screening by chest x-ray (CXR) and sputum cytology improves survival in a screened population. A number of subsequent studies using chest computed tomography (CT) in smokers revealed lesions suspect for cancer in around 20% and had a lung cancer detection rate of approx. 1%. Since these trials lacked a control arm, the question whether screening has an impact on lung cancer mortality remained unproven. Recently, the preliminary results of the randomised controlled National Lung Screening Trial (NLST), a study organised by the US National Cancer Institute, confirmed for the first time that lung cancer screening by CT is associated with a reduction in lung cancer mortality (20.3%) and in all-cause mortality (7%) compared with a control group undergoing CXR at the same time intervals. However, before lung cancer CT screening can be recommended, many open questions need to be answered with respect to costs and reimbursement, duration of an appropriate screening programme and its psychological impact.
大约三十年前，几项对照研究未能表明胸部 X 射线（CXR）和痰液细胞学检查筛查肺癌可提高筛查人群的生存率。随后的一些使用吸烟者胸部计算机断层扫描（CT）的研究显示，约有 20%的可疑癌症病变，肺癌检出率约为 1%。由于这些试验缺乏对照组，因此筛查是否对肺癌死亡率有影响仍未得到证实。最近，由美国国家癌症研究所组织的随机对照国家肺癌筛查试验（NLST）的初步结果首次证实，与同期接受 CXR 的对照组相比，CT 筛查肺癌可降低肺癌死亡率（20.3%）和全因死亡率（7%）。然而，在推荐肺癌 CT 筛查之前，需要回答许多有关成本和报销、适当筛查计划的持续时间及其心理影响的问题。
