title: Lung cancer screening:  making the transition from research to clinical practice.
abstract: OBJECTIVE
  The purpose of this review is to examine the literature on lung cancer screening with an emphasis on the prevalence of cancer in screen-detected nodules. On the basis of the evidence, we will then develop a practical approach to screen-detected lung nodules.
  
  
  RESULTS
  The first large randomized controlled trial using low-dose computed tomography (LDCT) found that persons undergoing three annual screening examinations with LDCT had a 20% relative reduction in lung cancer mortality as compared with those screened with annual chest X-rays. The probability of cancer in screen-detected nodules depends on their size and whether the nodules are detected on prevalence or incidence screens. The probability of cancer in screen-detected nodules ranges from 2.4 to 5.2%. Management strategies for screen-detected nodules that have been used successfully include careful observation using serial CT imaging, CT-guided fine needle biopsy, and surgery in carefully selected cases. The most frequently used strategies involve serial CT imaging and CT-guided biopsy for larger nodules and those that demonstrate growth on follow-up.
  
  
  CONCLUSIONS
  There is now evidence that LDCT in carefully selected high-risk populations can lead to better outcomes but the cost effectiveness of mass screening with LDCT is still unknown. Only patients at high risk for cancer should be screened.
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. hbgrosu@mdanderson.org
authors.forename: Horiana B
authors.initials: HB
authors.lastname: Grosu
authors.forename: George A
authors.initials: GA
authors.lastname: Eapen
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Jimenez
authors.forename: Rodolfo C
authors.initials: RC
authors.lastname: Morice
authors.forename: David
authors.initials: D
authors.lastname: Ost
mesh_terms: D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods