Ist Lungenkrebs-Screening sinnvoll?

Abstract

Lung cancer is the leading cause of cancer-related death in men and the second leading cause in women. Smoking cessation is the most effective measure to prevent development of lung cancer. Early detection trials with chest x-ray and sputum cytology failed to show reduction lung cancer mortality, despite the larger proportion of early-stage lung cancer diagnosed in the screened arm. The advent of low-dose chest computed tomography disclosed new perspectives. In 2011 an innovative, large prospective randomized controlled trial called "Reduced lung-cancer mortality with low-dose computed tomographic screening" was published and revealed reduced lung-cancer and overall mortality when persons at risk were annually screened by low-dose computed tomography compared to annually chest x-rays. At the moment, lung cancer screening cannot be recommended in general. It is uncertain for which duration screening should be continued, which screening modality is most appropriate and cost effective and what the psychological impact in case of indeterminate findings is. To avoid lung cancer screening programs being started imprudently, the Swiss healthcare system needs a provider independent commission mandated to continuously monitor ongoing screening trials, evaluate the results as well as the economical aspects, and make evidence based recommendations.