Lung cancer screening has the potential to save lives, but shall we do it?

EW Russi

doi:10.4414/smw.2011.13185

Review article: Biomedical intelligence

Vol. 141 No. 1516 (2011)

Lung cancer screening has the potential to save lives, but shall we do it?

EW Russi

DOI: https://doi.org/10.4414/smw.2011.13185
Cite this as:: Swiss Med Wkly. 2011;141:w13185
Published: 11.04.2011

Summary

Almost three decades ago several controlled studies failed to show that lung cancer screening by chest x-ray (CXR) and sputum cytology improves survival in a screened population. A number of subsequent studies using chest computed tomography (CT) in smokers revealed lesions suspect for cancer in around 20% and had a lung cancer detection rate of approx. 1%. Since these trials lacked a control arm, the question whether screening has an impact on lung cancer mortality remained unproven. Recently, the preliminary results of the randomised controlled National Lung Screening Trial (NLST), a study organised by the US National Cancer Institute, confirmed for the first time that lung cancer screening by CT is associated with a reduction in lung cancer mortality (20.3%) and in all-cause mortality (7%) compared with a control group undergoing CXR at the same time intervals. However, before lung cancer CT screening can be recommended, many open questions need to be answered with respect to costs and reimbursement, duration of an appropriate screening programme and its psychological impact.

References

CA Cancer J Clin 1980;30:295–301. Classics in oncology. Adler IA: Primary malignant growths of the lung and bronchi. New York, Longmans, Green and Co., 1912.
Doll R, Hill AB. Smoking and carcinoma of the lung: a preliminary report, BMJ. 1950;2:739–48.
Wynder EL, Graham EA. Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma. JAMA. 1950;143:329–36.
Doll R, Hill AB. The mortality of doctors in relation to their smoking habits: a preliminary report. BMJ.1954;228,1451–5.
Doll R, Hill AB. Lung cancer and other causes of death in relation to smoking: a second report on the mortality of British doctors. BMJ. 1956;233:1071–6.
Cancer in Switzerland. Situation and development from 1938 to 2007. http://www.nicer.org/editor/files/Krebs_in_der_Schweiz_e.pdf.
Bundesamt für Statistik; Einzelne Krebskrankheiten: Lungenkrebs: http://www.bfs.admin.ch/bfs/portal/de/index/themen/14/02/05/key/02/03.html
Flehinger BJ, Melamed MR, Zaman MB, Heelan RT, Perchick WB, Martini N. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Memorial Sloan-Kettering study. Am Rev Respir Dis. 1984;130:555–60.
Frost JK, Ball WC Jr., Levin ML et al. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Johns Hopkins study. Am Rev Respir Dis. 1984;130:549–54.
Tockman MS. Survival and mortality from lung cancer in a screened population: The Johns Hopkins Study. Chest. 1986;89(suppl):324S–5S.
Fontana RS, Sanderson DR, Taylor WF et al. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo Clinic study. Am Rev Respir Dis. 1984;130:561–5.
Kubík A, Polák J. Lung cancer detection: results of a randomized prospective study in Czechoslovakia. Cancer. 1986;57:2427–37.
Henschke CI, McCauley DI, Yankelevitz DF, Naidich DP et al. Early lung cancer action project: overall design and findings from baseline screening. Lancet. 1999;354:99–105.
http://www.cancer.gov/clinicaltrials/noteworthy-trials/nlst.
National Lung Screening Trial Research Team. The National Lung Screening Trial: Overview and Study Design. Radiology. 2011;258:243–53.
Pastorino U. Lung cancer screening. B J Cancer. 2010;102:1681–6.
Patnick J, Blanks R. Maximising benefit and minimising harm of screening. BMJ. 2008;336:480–3.
Zwahlen M, Low N, Borisch B, Egger M, Künzli N, Obrist R, Paccaud F, Zybach U, Probst-Hensch NM. Population based screening – the difficulty of how to do more good than harm and how to achieve it. Swiss Med Weekly. 2010;140:3–10.
Crispo A, Brennan P, Jöckel KH, Schaffraht-Rosario A, Wichmann HE, Nyberg F, Simonato L, Merletti F, Forastiere F, Boffetta P. Darby S. The cumulative risk of lung cancer among current, ex- and never-smokers in European men. Br J Cancer. 2004;91:1280–6.
Van den Bergh KA, Essink-Bot ML, Bunge EM, Scholten ET, Prokop M, van Iersel CA, van Klaveren RJ, de Koning HJ. Impact of computed tomography screening for lung cancer on participants in a randomised controlled trial (NELSON trial). Cancer. 2008;113:396–404.

How to Cite

1.

Russi E. Lung cancer screening has the potential to save lives, but shall we do it?. Swiss Med Wkly [Internet]. 2011 Apr. 11 [cited 2024 Nov. 23];141(1516):w13185. Available from: https://smw.ch/index.php/smw/article/view/1269

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

[1] CA Cancer J Clin 1980;30:295–301. Classics in oncology. Adler IA: Primary malignant growths of the lung and bronchi. New York, Longmans, Green and Co., 1912.

[2] Doll R, Hill AB. Smoking and carcinoma of the lung: a preliminary report, BMJ. 1950;2:739–48.

[3] Wynder EL, Graham EA. Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma. JAMA. 1950;143:329–36.

[4] Doll R, Hill AB. The mortality of doctors in relation to their smoking habits: a preliminary report. BMJ.1954;228,1451–5.

[5] Doll R, Hill AB. Lung cancer and other causes of death in relation to smoking: a second report on the mortality of British doctors. BMJ. 1956;233:1071–6.

[6] Cancer in Switzerland. Situation and development from 1938 to 2007. http://www.nicer.org/editor/files/Krebs_in_der_Schweiz_e.pdf.

[7] Bundesamt für Statistik; Einzelne Krebskrankheiten: Lungenkrebs: http://www.bfs.admin.ch/bfs/portal/de/index/themen/14/02/05/key/02/03.html

[8] Flehinger BJ, Melamed MR, Zaman MB, Heelan RT, Perchick WB, Martini N. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Memorial Sloan-Kettering study. Am Rev Respir Dis. 1984;130:555–60.

[9] Frost JK, Ball WC Jr., Levin ML et al. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Johns Hopkins study. Am Rev Respir Dis. 1984;130:549–54.

[10] Tockman MS. Survival and mortality from lung cancer in a screened population: The Johns Hopkins Study. Chest. 1986;89(suppl):324S–5S.

[11] Fontana RS, Sanderson DR, Taylor WF et al. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo Clinic study. Am Rev Respir Dis. 1984;130:561–5.

[12] Kubík A, Polák J. Lung cancer detection: results of a randomized prospective study in Czechoslovakia. Cancer. 1986;57:2427–37.

[13] Henschke CI, McCauley DI, Yankelevitz DF, Naidich DP et al. Early lung cancer action project: overall design and findings from baseline screening. Lancet. 1999;354:99–105.

[14] http://www.cancer.gov/clinicaltrials/noteworthy-trials/nlst.

[15] National Lung Screening Trial Research Team. The National Lung Screening Trial: Overview and Study Design. Radiology. 2011;258:243–53.

[16] Pastorino U. Lung cancer screening. B J Cancer. 2010;102:1681–6.

[17] Patnick J, Blanks R. Maximising benefit and minimising harm of screening. BMJ. 2008;336:480–3.

[18] Zwahlen M, Low N, Borisch B, Egger M, Künzli N, Obrist R, Paccaud F, Zybach U, Probst-Hensch NM. Population based screening – the difficulty of how to do more good than harm and how to achieve it. Swiss Med Weekly. 2010;140:3–10.

[19] Crispo A, Brennan P, Jöckel KH, Schaffraht-Rosario A, Wichmann HE, Nyberg F, Simonato L, Merletti F, Forastiere F, Boffetta P. Darby S. The cumulative risk of lung cancer among current, ex- and never-smokers in European men. Br J Cancer. 2004;91:1280–6.

[20] Van den Bergh KA, Essink-Bot ML, Bunge EM, Scholten ET, Prokop M, van Iersel CA, van Klaveren RJ, de Koning HJ. Impact of computed tomography screening for lung cancer on participants in a randomised controlled trial (NELSON trial). Cancer. 2008;113:396–404.