title: Lung cancer screening: history, current perspectives, and future directions.
abstract: Lung cancer has remained the leading cause of death worldwide among all cancers. The dismal 5-year survival rate of 16% is in part due to the lack of symptoms during early stages and lack of an effective screening test until recently. Chest X-ray and sputum cytology were studied extensively as potential screening tests for lung cancer and were conclusively proven to be of no value. Subsequently, a number of studies compared computed tomography (CT) with the chest X-ray. These studies did identify lung cancer in earlier stages. However, they were not designed to prove a reduction in mortality. Later trials have focused on low-dose CT (LDCT) as a screening tool. The largest US trial - the National Lung Screening Trial (NLST) - enrolled approximately 54,000 patients and revealed a 20% reduction in mortality. While a role for LDCT in lung cancer screening has been established, the issues of high false positive rates, radiation risk, and cost effectiveness still need to be addressed. The guidelines of the international organizations that now include LDCT in lung cancer screening are reviewed. Other methods that may improve earlier detection such as positron emission tomography, autofluorescence bronchoscopy, and molecular biomarkers are also discussed.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, NY, USA.
authors.forename: Divakar
authors.initials: D
authors.lastname: Sharma
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, NY, USA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Newman
authors.affiliation: Divisions of Cardiology, and Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla NY, USA ; Divisions of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla NY, USA.
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
keywords: low-dose computed tomography scan; lung cancer screening