Low-dose computerized tomography in lung cancer screening

Abstract

Lung cancer screening has been a passionately debated topic since the late 1990s. Five-year survival is 53.5 %, 26.1 %, and 3.9 % when cancer is confined to the lung at the time of diagnosis, when there is regional nodal involvement, and when there is distant metastasis, respectively. The goal of lung cancer screening (LCS) is to shift the timing of the diagnosis to an earlier point, thus, the disease is localized to the lung, and then appropriate treatment can reduce the mortality of lung cancer. Study results from several lung cancer screening trials worldwide, including the United States, Japan, the Netherlands, Denmark, and Italy demonstrated that low-dose computerized tomography (LDCT) scanner used in LCS can increase the detection rate of lung cancer at an earlier stage. At the time of screening, the information about smoking cessation should be provided to all current smokers, while the multidisciplinary clinic affords a second opportunity to counsel patients about the benefits of quitting smoking. After two rounds of screening, there are fewer false positives as a result of comparison with the baseline screening CT that may reveal two years of pulmonary nodule stability. Decreasing the number of false -positive lung cancer screens is an area for future research. Genetic profiles and the results of the baseline screening examination can potentiate further refining the risk modeling. Risk modeling could define the frequency of follow-up in addition to who should be screened. In conclusion, LCS with LDCT has shown that there are indolent lung cancers that may not be fatal. Further studies are urgently needed if the maximization of the risk-benefit ratio in LCS has to be achieved.