The importance of screening for lung cancer

Abstract

Lung cancer is a major public health problem as it causes the most cancer-related deaths worldwide. As the disease often causes no symptoms at early stages, diagnosis at advanced stages, wherein cure is no longer possible, is common. Improvements in lung cancer treatment have been made, but yielded only modest improvement in survival over the last decades. Continuous efforts should be made to force back exposure to causative agents of lung cancer, tobacco smoking in particular. However, this is not expected to reverse the lung cancer epidemic in the next decades. Lung cancer screening can reduce morbidity and mortality by detecting lung cancer at an early and curable stage. Initial estimates of many harms and benefits of screening have been made, suggesting that the benefits of low-dose computed tomography screening outweigh the harms. Finally, the success of an implemented screening program is determined by the benefit it will yield for public health.

Keywords::

• benefit
• epidemiology
• harm
• low-dose computed tomography
• lung cancer
• mass screening
• prevention
• public health

Financial & competing interests disclosure

N Horeweg has no disclosures. HJd Koning has no disclosures relevant to this article. Both authors are involved in the Dutch-Belgian NELSON lung cancer screening trial. The NELSON trial is supported by: ‘Zorg Onderzoek Nederland-Medische Wetenschappen’ (ZonMw), ‘KWF Kankerbestrijding’, ‘Stichting Centraal Fonds Reserves van Voormalig Vrijwillige Ziekenfondsverzekeringen’ (RvvZ). Roche diagnostics provided a grant for the performance of proteomics-research. Siemens Germany provided four digital workstations and LungCARE for the performance of 3D measurements. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Lung cancer is an important public health problem since it causes most cancer-related deaths worldwide.

• Lung cancer often causes no symptoms at the early stages of disease, as a result, diagnosis at advanced stages wherein cure is no longer possible is common.

• Improvements in lung cancer treatment have been made, but yielded only modest improvement in the survival over the last decades.

• Continuous efforts should be made to force back exposure to causative agents of lung cancer, tobacco smoking in particular; however, this is not expected to reverse the lung cancer epidemic in the next decades.

• Screening aims to reduce morbidity and mortality by detecting lung cancer at an early and curable stage.

• Since screening is always accompanied by harms and only effective screening has benefits, implementation should depend on the balance between harms and benefits and cost–effectiveness.

• Initial estimates of many harms and benefits of screening have been made, suggesting that the benefits of low-dose computed tomography screening outweigh the harms.

• The success of an implemented screening program is determined by the benefits it yield for public health.

• Effectiveness of tertiary prevention has not been demonstrated; however, raising public awareness on lung cancer may contribute to the development and funding of research, screening, clinical care and aftercare.

Notes