Current Oncology Reports

, Volume 12, Issue 4, pp 226–234 | Cite as

Lung Cancer Screening: An Update, Discussion, and Look Ahead



Over the past few years there has been a great deal of debate about the status of lung cancer screening. The debate has focused on at least three areas: the unmet need to prove a mortality reduction from the screening tests being studied, the potential for these screening tests to produce harm, and the possible cost-effectiveness of an image-based screening program. In this manuscript, I review the chest imaging cohort and controlled trials that have been added to the evidence base over the past few years. I then discuss the evidence related to the areas that are currently debated, describe the ongoing trials that will help to clarify these issues, and speculate about the future.


Lung cancer Screening Bias Over-diagnosis Lung nodules Cost-effectiveness 



Dr. Mazzone served as a consultant at an advisory board meeting for the company Oncimmune; they are developing a blood test for lung cancer detection.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Mazzone PJ, Mekhail T: Lung cancer screening. Curr Oncol Rep 2007, 9:265–274.CrossRefPubMedGoogle Scholar
  2. 2.
    New York Early Lung Cancer Project Investigators: CT screening for lung cancer: Diagnoses resulting from the New York Early Lung Cancer Action Project. Radiology 2007, 243:239–249.CrossRefGoogle Scholar
  3. 3.
    Roberts HC, Patsios D, Paul NS, et al.: Lung cancer screening with low-dose computed tomography: Canadian experience. CARJ 2007, 58:225–235.Google Scholar
  4. 4.
    Veronesi G, Bellomi M, Scanagatta P, et al.: Difficulties encountered managing nodules detected during a computed tomography lung cancer screening program. J Thorac Cardiovasc Surg 2008, 136:611–617.CrossRefPubMedGoogle Scholar
  5. 5.
    Wilson DO, Weissfeld JL, Fuhrman CR, et al.: The Pittsburgh Lung Screening Study (PLuSS). Outcomes within 3 years of a first computed tomography scan. Am J Respir Crit Care Med 2008, 178:956–961.CrossRefPubMedGoogle Scholar
  6. 6.
    Fasola G, Belvedere O, Aita M, et al.: Low-dose computed tomography screening for lung cancer and pleural mesothelioma in an asbestos-exposed population; Baseline results of a prospective, nonrandomized feasibility trial—An Alpe-Adria Thoracic Oncology Multidisciplinary Group Study (ATOM 002). The Oncologist 2007, 12:1215–1224.CrossRefPubMedGoogle Scholar
  7. 7.
    Blanchon T, Brechot JM, Grenier PA, et al.: Baseline results of the Depiscan study: A French randomized pilot trial of lung cancer screening comparing low dose CT scan (LDCT) and chest x-ray (CXR). Lung Cancer 2007, 58:50–58.CrossRefPubMedGoogle Scholar
  8. 8.
    Pedersen JH, Ashraf H, Dirksen A, et al.: The Danish randomized lung cancer CT screening trial—Overall design and results of the prevalence round. J Thorac Oncol 2009, 4:608–614.CrossRefPubMedGoogle Scholar
  9. 9.
    • Infante M, Cavuto S, Lutman FR, et al.: A randomized study of lung cancer screening with spiral computed tomography. Three-year results from the DANTE trial. Am J Respir Crit Care Med 2009, 180:445–453. This randomized, controlled trial of chest CT screening for lung cancer reports outcomes at 33 months of follow-up, longer than any other controlled trial to date. A stage shift and mortality reduction was not seen, though the study is relatively small and early in its follow-up.CrossRefPubMedGoogle Scholar
  10. 10.
    Pegna AL, Picozzi G, Mascalchi M, et al.: Design, recruitment and baseline results of the ITALUNG trial for lung cancer screening with low-dose CT. Lung Cancer 2009, 64:34–40.CrossRefGoogle Scholar
  11. 11.
    Fontana RS, Sanderson DR, Woolner LB, et al.: Screening for lung cancer. A critique of the Mayo Lung Project. Cancer 1991, 67:1155–1164.CrossRefPubMedGoogle Scholar
  12. 12.
    The International Early Lung Cancer Action Program Investigators: Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 2006, 355:1763–1771.CrossRefGoogle Scholar
  13. 13.
    Bach PB, Jett JR, Patorino U, et al.: Computed tomographic screening and lung cancer outcomes. JAMA 2007, 297:953–961.CrossRefPubMedGoogle Scholar
  14. 14.
    Gohagan JK, Marcus PM, Fagerstrom RM, et al.: Final results of the lung screening study, a randomized feasibility study of spiral CT versus chest x-ray screening for lung cancer. Lung Cancer 2005, 47:9–15.CrossRefPubMedGoogle Scholar
  15. 15.
    Weiss W: Implications of tumor growth rate for the natural history of lung cancer. J Occup Med 1984, 26:345–352.CrossRefPubMedGoogle Scholar
  16. 16.
    Winer-Muram HT, Jennings SG, Tarver RD, et al.: Volumetric growth rate of stage I lung cancer prior to treatment: Serial CT scanning. Radiology 2002, 223:798–805.CrossRefPubMedGoogle Scholar
  17. 17.
    Hasegawa M, Sone S, Takashima S, et al.: Growth rate of small lung cancers detected on mass CT screening. Br J Radiol 2000, 73:1252–1259.PubMedGoogle Scholar
  18. 18.
    Jennings SG, Winer-Muram HT, Tann M, et al.: Distribution of stage I lung cancer growth rates determined with serial volumetric CT measurements. Radiology 2006, 241:554–563.CrossRefPubMedGoogle Scholar
  19. 19.
    Sone S, Li F, Yang ZG, et al.: Results of three-year mass screening programme for lung cancer using mobile low-dose spiral computed tomography scanner. Br J Cancer 2001, 84:25–32.CrossRefPubMedGoogle Scholar
  20. 20.
    Swensen SJ, Jett JR, Hartman TE, et al.: CT screening for lung cancer: Five-year prospective experience. Radiology 2005, 235:259–265.CrossRefPubMedGoogle Scholar
  21. 21.
    • Kawachi R, Watanabe S, Asamura H: Clinicopathological characteristics of screen-detected lung cancers. J Thorac Oncol 2009, 4:615–619. This report from Japan is a retrospective review of lung cancers resected after detection clinically, versus those detected through screening. It highlights some of the differences in the cancers detected, which may impact our interpretation of noncontrolled screening trials.CrossRefPubMedGoogle Scholar
  22. 22.
    Raz DJ, Zell JA, Ou I, et al.: Natural history of stage I non-small cell lung cancer: Implications for early detection. Chest 2007, 132:193–199.CrossRefPubMedGoogle Scholar
  23. 23.
    Yankelevitz DF, Kostis WJ, Henschke CI, et al.: Overdiagnosis in chest radiographic screening for lung carcinoma. Cancer 2003, 97:1271–1275.CrossRefPubMedGoogle Scholar
  24. 24.
    Reich JM: A critical appraisal of overdiagnosis: estimates of its magnitude and implications for lung cancer screening. Thorax 2008, 63:377–383.CrossRefPubMedGoogle Scholar
  25. 25.
    Bianchi F, Hu J, Pelosi G, et al.: Lung cancers detected by screening with spiral computed tomography have a malignant phenotype when analyzed by cDNA microarray. Clin Cancer Res 2004, 10:6023–6028.CrossRefPubMedGoogle Scholar
  26. 26.
    Read WL, Tierney RM, Page NC, et al.: Differential prognostic impact of comorbidity. J Clin Oncol 2004, 22:3099–3103.CrossRefPubMedGoogle Scholar
  27. 27.
    Marcus PM, Bergstralh EJ, Zweig MH, et al.: Extended lung cancer incidence follow-up in the Mayo Lung Project and overdiagnosis. J Natl Cancer Inst 2006, 98:748–756.PubMedGoogle Scholar
  28. 28.
    Manser RL, Dodd M, Byrnes G, et al.: Incidental lung cancers identified at coronial autopsy: implications for overdiagnosis of lung cancer by screening. Respir Med 2005, 99:501–507.CrossRefPubMedGoogle Scholar
  29. 29.
    Chan CK, Wells CK, McFarlane MJ, Feinstein AR: More lung cancer but better survival. Implications of secular trends in “necropsy surprise” rates. Chest 1989, 96:291–296.CrossRefPubMedGoogle Scholar
  30. 30.
    Swensen SJ, Jett JR, Hartman TE, et al.: CT screening for lung cancer: Five-year prospective experience. Radiology 2005, 235:259–265.CrossRefPubMedGoogle Scholar
  31. 31.
    van den Bergh KAM, Essink-Bot ML, Bunge EM, et al.: Impact of computed tomography screening for lung cancer on participants in a randomized controlled trial (NELSON Trial). Cancer 2008, 113:396–404.CrossRefPubMedGoogle Scholar
  32. 32.
    Pastorino U, Bellomi M, Landoni C, et al.: Early lung-cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results. Lancet 2003, 362:593–597.CrossRefPubMedGoogle Scholar
  33. 33.
    Bastarrika G, Garcia-Velloso MJ, Lozano MD, et al.: Early lung cancer detection using spiral computed tomography and positron emission tomography. Am J Respir Crit Care Med 2005, 171:1378–1383.CrossRefPubMedGoogle Scholar
  34. 34.
    Lindell RM, Hartman TE, Swensen SJ, et al.: Lung cancer screening experience: A retrospective review of PET in 22 non-small cell lung carcinomas detected on screening chest CT in a high-risk population. AJR 2005, 185:126–131.PubMedGoogle Scholar
  35. 35.
    Infante M, Lutman FR, Cavuto S, et al.: Lung cancer screening with spiral CT. Baseline results of the randomized DANTE trial. Lung Cancer 2008, 59:355–363.PubMedGoogle Scholar
  36. 36.
    • van Klaveren RJ, Oudkerk M, Prokop M, et al.: Management of lung nodules detected by volume CT scanning. N Engl J Med 2009, 361:2221–2229. This study describes the use of volumetric measurements in lung nodule assessment as part of a controlled lung cancer screening trial. It highlights the need to determine strategies that minimize the impact of false-positive findings.CrossRefPubMedGoogle Scholar
  37. 37.
    • Fazel R, Krumholz HM, Wang Y, et al.: Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 2009, 361:849–857. This study shows us the relatively large amounts of ionizing radiation individuals are exposed to from current medical imaging. Lung cancer screening CT programs would add to this.CrossRefPubMedGoogle Scholar
  38. 38.
    Einstein AJ, Henzlova MJ, Rajagopalan S: Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 2007, 298:317–323.CrossRefPubMedGoogle Scholar
  39. 39.
    Mahadevia PJ, Fleisher LA, Frick KD, et al.: Lung cancer screening with helical computed tomography in older adult smokers. A decision and cost-effectiveness analysis. JAMA 2003, 289:313–322.CrossRefPubMedGoogle Scholar
  40. 40.
    • Silvestri GA, Nietert PJ, Zoller J, et al.: Attitudes towards screening for lung cancer among smokers and their non-smoking counterparts. Thorax 2007, 62:126–130. This study highlights the difficulty of taking a screening program from the trial setting to a clinical setting. Many people surveyed who would qualify for screening using common criteria would choose not to participate or not to have a screen-detected cancer treated. CrossRefPubMedGoogle Scholar
  41. 41.
    Oken MM, Marcus PM, Hu P, et al.: Baseline chest radiograph for lung cancer detection in the randomized prostate, lung, colorectal, and ovarian cancer screening trial. J Natl Cancer Inst 2005, 97:1832–1839.PubMedCrossRefGoogle Scholar
  42. 42.
    Gohagan J, Marcus P, Fagerstrom R, et al.: Baseline findings of a randomized feasibility trial of lung cancer screening with spiral CT scan vs. chest radiograph: The Lung Screening Study of the National Cancer Institute. Chest 2004, 126:114–121.CrossRefPubMedGoogle Scholar
  43. 43.
    Bach PB, Kattan MW, Thornquist MD, et al.: Variations in lung cancer risk among smokers. J Natl Cancer Inst 2003, 95:470–478.PubMedCrossRefGoogle Scholar
  44. 44.
    Bach PB, Elkin EB, Pastorino U, et al.: Benchmarking lung cancer mortality rates in current and former smokers. Chest 2004, 126:1742–1749.CrossRefPubMedGoogle Scholar
  45. 45.
    Bechtel JJ, Kelley WA, Coons TA, et al.: Lung cancer detection in patients with airflow obstruction identified in a primary care outpatient practice. Chest 2005, 127:1140–1145.CrossRefPubMedGoogle Scholar
  46. 46.
    Fan Y, Hu P, Jiang Y, et al.: Association between sputum atypia and lung cancer risk in an occupational cohort in Yunnan, China. Chest 2009, 135:778–785.CrossRefPubMedGoogle Scholar
  47. 47.
    Mazzone PJ: Analysis of volatile organic compounds in the exhaled breath for lung cancer diagnosis. J Thorac Oncol 2008, 3:774–780.CrossRefPubMedGoogle Scholar
  48. 48.
    Carpagnano GE, Foschino-Barbaro MP, Spanevello A, et al.: 3p microsatellite signature in exhaled breath condensate and tumor tissue of patients with lung cancer. Am J Respir Crit Care Med 2008, 177:337–341.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Respiratory Institute, Cleveland ClinicClevelandUSA

Personalised recommendations