Lung Cancer Screening: Achieving a Reduction in Mortality

Abstract

m i November 4, 2010, marked a turning point in the history of screening for lung cancer. On that date, the National ancer Institute announced that the National Lung Screening rial (NLST) had achieved a 20% reduction in lung cancer ortality in the computed tomography (CT) arm of its ranomized controlled trial.1 This large randomized controlled trial followed multiple single-arm CT screening trials, which had demonstrated an increase in the number of early-stage lung cancers, and had suggested the possibility of a stage shift. In other words, screening for lung cancer with multidetector computed tomography (MDCT) could potentially convert lung cancer from a disease that is predominantly diagnosed in late stages to one that is detected at a point at which a cure is a possibility. Forty years of research paved the way for this new approach to diagnosing lung cancer. To best understand the extensive effort that preceded this announcement, it can be helpful to review lung cancer screening from a historical perspective, including chest radiography screening trials, and both single-arm and randomized controlled CT screening trials. Although the 5-year survival in lung cancer has remained for years at a dismally low 16%, screening for lung cancer with CT offers a ray of hope that these statistics could change.