Implementing Lung Cancer Screening in the Real World
Implementing Lung Cancer Screening in the Real World
The World Health Organization estimates that, in 2012, there were 1,589,925 deaths from lung cancer worldwide. Screening for lung cancer with low-dose computed tomography (LDCT) has the potential to significantly alter this statistic, by identifying lung cancers in earlier stages, enabling curative treatment. Challenges remain, however, in replicating the 20% mortality benefit demonstrated by the National Lung Screening Trial (NLST), in populations outside the confines of a research trial, not only in the US but around the world. We review the history of lung cancer screening, the current evidence for LDCT screening, and the key elements needed for a successful screening program.
Lung cancer is a devastating disease, with the majority of patients diagnosed in advanced stages, resulting in an overall 5-year survival of only 18%. National Cancer Institute (NCI) data for non-small cell lung cancer in the United States (US) for the period from 2005 through 2011 showed that only 16% of lung cancers are diagnosed at a localized stage, and the majority, 57%, is diagnosed with distant disease. The goal of screening for lung cancer is to reduce lung cancer mortality by increasing the number of cases diagnosed at a localized stage, thereby allowing a curative approach to treatment. In 2011, the largest randomized controlled trial of CT screening for lung cancer to date, the National Lung Screening Trial (NLST), changed the face of early detection of lung cancer when it reported a 20% reduction in lung-cancer specific mortality in a high-risk cohort of patients screened in the US with CT in comparison with the control arm of high-risk individuals screened with annual chest radiographs (CXR) for 3 years. In contrast to symptom-detected lung cancers, the majority (63%) of CT-screen-detected lung cancers was Stage I, and only 12.8% with a positive screen had distant disease. The optimistic approach to these results is that CT screening could shift the lung cancer population from one dominated by advanced, incurable disease to a population with a high percentage of early stage, resectable disease. On the other hand, it is yet to be shown if the NLST results can be generalized either to the community setting within the US or to countries outside the US. In this article, we will explore the issues driving the lung cancer screening debate.
Abstract and Introduction
Abstract
The World Health Organization estimates that, in 2012, there were 1,589,925 deaths from lung cancer worldwide. Screening for lung cancer with low-dose computed tomography (LDCT) has the potential to significantly alter this statistic, by identifying lung cancers in earlier stages, enabling curative treatment. Challenges remain, however, in replicating the 20% mortality benefit demonstrated by the National Lung Screening Trial (NLST), in populations outside the confines of a research trial, not only in the US but around the world. We review the history of lung cancer screening, the current evidence for LDCT screening, and the key elements needed for a successful screening program.
Introduction
Lung cancer is a devastating disease, with the majority of patients diagnosed in advanced stages, resulting in an overall 5-year survival of only 18%. National Cancer Institute (NCI) data for non-small cell lung cancer in the United States (US) for the period from 2005 through 2011 showed that only 16% of lung cancers are diagnosed at a localized stage, and the majority, 57%, is diagnosed with distant disease. The goal of screening for lung cancer is to reduce lung cancer mortality by increasing the number of cases diagnosed at a localized stage, thereby allowing a curative approach to treatment. In 2011, the largest randomized controlled trial of CT screening for lung cancer to date, the National Lung Screening Trial (NLST), changed the face of early detection of lung cancer when it reported a 20% reduction in lung-cancer specific mortality in a high-risk cohort of patients screened in the US with CT in comparison with the control arm of high-risk individuals screened with annual chest radiographs (CXR) for 3 years. In contrast to symptom-detected lung cancers, the majority (63%) of CT-screen-detected lung cancers was Stage I, and only 12.8% with a positive screen had distant disease. The optimistic approach to these results is that CT screening could shift the lung cancer population from one dominated by advanced, incurable disease to a population with a high percentage of early stage, resectable disease. On the other hand, it is yet to be shown if the NLST results can be generalized either to the community setting within the US or to countries outside the US. In this article, we will explore the issues driving the lung cancer screening debate.
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