Lung cancer screening and prevention
Lung cancer mortality has been declining since the 1990s largely due to decreases in smoking, yet it remains the leading cause of cancer mortality in the United States. While effective screening tests have been available for the three other cancers with highest mortality in the United States, specifically breast, colorectal, and prostate cancers, lung cancer screening (LCS) has become available only in recent years. Early attempts at developing a LCS test focused largely on chest radiography, often in conjunction with sputum cytology, though those modalities have since been shown to not be effective screening methods. More recently, studies have focused on screening with low-dose computed tomography (LDCT). These recent and ongoing studies differ considerably from each other in gender ratios, age cutoffs, and total number of pack-years of smoking burden for participants. The National Lung Screening Trial was the first prospective randomized trial to demonstrate that screening individuals at high risk for lung cancer with LDCT could decrease mortality. In 2013, the US Preventative Services Task Force provided a “grade B” recommendation for annual screening for lung cancer using LDCT in adults aged 55 to 80 years with a 30 pack-year smoking history, who currently smoke or quit within the past 15 years. National guidelines now standardize findings on LDCT screening examinations and delineate next steps for additional evaluation and follow-up. Ongoing work to refine LCS screening algorithms, identify individuals most likely to benefit from screening, and increase adoption of screening will likely improve its future utility.
