Why and how would we implement a lung cancer screening program?

• Type of Material: Article
• Authors: Idris Guessous, Emory University; Jacques Cornuz, University of Lausanne
• Language: English
• Date: 2015-11-05
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © Guessous and Cornuz. 2015
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s40985-015-0010-3
• Title of Journal or Parent Work: Public Health Reviews
• ISSN: 0301-0422
• Volume: 36
• Issue: 1
• Keywords: Screening; Smoking; Lung cancer; Implementation; Evidence; Overdiagnosis; Low dose computed tomography
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

For decades, lung cancer has been the most common cancer in terms of both incidence and mortality. There has been very little improvement in the prognosis of lung cancer. Early treatment following early diagnosis is considered to have potential for development. The National Lung Screening Trial (NLST), a large, well-designed randomized controlled trial, evaluated low-dose computed tomography (LDCT) as a screening tool for lung cancer. Compared with chest X-ray, annual LDCT screening reduced death from lung cancer and overall mortality by 20 and 6.7 %, respectively, in high-risk people aged 55–74 years. Several smaller trials of LDCT screening are under way, but none are sufficiently powered to detect a 20 % reduction in lung cancer death. Thus, it is very unlikely that the NLST results will be replicated. In addition, the NLST raises several issues related to screening, such as the high false-positive rate, overdiagnosis and cost. Healthcare providers and systems are now left with the question of whether the available findings should be translated into practice. We present the main reasons for implementing lung cancer screening in high-risk adults and discuss the main issues related to lung cancer screening. We stress the importance of eligibility criteria, smoking cessation programs, primary care physicians, and informed-decision making should lung cancer screening be implemented. Seven years ago, we were waiting for the results of trials. Such evidence is now available. Similar to almost all other cancer screens, uncertainties exist and persist even after recent scientific efforts and data. We believe that by staying within the characteristics of the original trial and appropriately sharing the evidence as well as the uncertainties, it is reasonable to implement a LDCT lung cancer screening program for smokers and former smokers.