Abstract
Lung cancer remains the leading cause of cancer-related death in the United States. Cigarette smoking is a well-recognized risk factor for lung cancer, and a sustained elevation of lung cancer risk persists even after smoking cessation. Despite identifiable risk factors, there has been minimal improvement in mortality for patients with lung cancer primarily stemming from diagnosis at a late stage when there are few effective therapeutic options. Early detection of lung cancer and effective screening of high-risk individuals may help improve lung cancer mortality. While low dose computerized tomography (LDCT) screening of high risk smokers has been shown to reduce lung cancer mortality, the high rates of false positives and potential for over-diagnosis have raised questions on how to best implement lung cancer screening. The rapidly evolving field of lung cancer screening and early-detection biomarkers may ultimately improve the ability to diagnose lung cancer in its early stages, identify smokers at highest-risk for this disease, and target chemoprevention strategies. This review aims to provide an overview of the opportunities and challenges related to lung cancer screening, the field of biomarker development for early lung cancer detection, and the future of lung cancer chemoprevention.
Highlights
Lung cancer is the leading cause of cancer mortality, accounting for almost 27% of all cancer-related deaths [1] and 20% of total U.S Medicare expenditures for cancer [2]
This review will provide an overview of the progress that has been made in lung cancer screening, early detection, chemoprevention, and biomarker development using surrogate tissues
The potential impact of such a high rate of false positives, such as financial cost, potential complications from additional diagnostic evaluation including biopsy or thoracic surgery, and anxiety associated with diagnostic uncertainty [31,32], is not insignificant when applied to a large-scale screening program
Summary
Lung cancer is the leading cause of cancer mortality, accounting for almost 27% of all cancer-related deaths [1] and 20% of total U.S Medicare expenditures for cancer [2]. An estimated 85% of lung cancer cases in the United States are caused by cigarette smoking [4]. This review will provide an overview of the progress that has been made in lung cancer screening, early detection, chemoprevention, and biomarker development using surrogate tissues. It will discuss some of the progress and controversies in these areas, and how evolving technologies may improve our ability to target interventions for the subpopulations at highest risk for lung cancer. The prime focus of this review is on smoking-associated lung cancer since cigarette smoking is a major contributor to development of this disease
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