The Authors: Professor Stephen Spiro was a Consultant Physician at The Royal Brompton Hospital (1977–1994) and University College London Hospitals (1977–2008). He now holds honorary positions at both institutions. He was an Editor of Thorax (1991–1996), a founder member (1990) and President of the European Respiratory Society (1997) and President of the British Thoracic Society (2003). He has lead or participated in many clinical trials on the treatment of lung cancer and is currently the Chief Investigator for a multicentre UK trial of screening in lung cancer. He is the Deputy Chair of the British Lung Foundation. Dr Neal Navani qualified in Medicine from the University of Cambridge and University College London in 2000. He was awarded a Medical Research Council Research Training Fellowship in 2008 and completed a PhD at University College London in 2011. He has also completed an MSc in Clinical Trials at The London School of Hygiene and Tropical Medicine. In 2011 he was appointed as Consultant in Thoracic Medicine at University College London Hospital.
Screening for lung cancer: Is this the way forward?
Article first published online: 24 JAN 2012
© 2011 The Authors. Respirology © 2011 Asian Pacific Society of Respirology
Volume 17, Issue 2, pages 237–246, February 2012
How to Cite
SPIRO, S. G. and NAVANI, N. (2012), Screening for lung cancer: Is this the way forward?. Respirology, 17: 237–246. doi: 10.1111/j.1440-1843.2011.02114.x
Review criteria: The information for this review was compiled by searching the PubMed and Medline databases for articles published before 18 August 2011. Electronic early release publications were also included. Only articles published in English were considered. The following search terms were used ‘lung cancer screening’, ‘low-dose computed tomography’ and ‘early stage lung cancer’. Full articles were obtained, and references were checked for additional material, as appropriate. References were chosen on the basis of the highest quality clinical evidence.
SERIES EDITORS: JOHN E HEFFNER AND DAVID CL LAM
- Issue published online: 24 JAN 2012
- Article first published online: 24 JAN 2012
- Accepted manuscript online: 5 DEC 2011 08:41AM EST
- Received 30 August 2011; accepted 12 October 2011.
- high risk;
- low-dose computed tomography;
- noncalcified nodules;
- overdiagnosis bias;
While low-dose CT scans have been shown to detect greater numbers of early lung cancers than conventional CXR, the first randomized trial of CT versus CXR screening in more than 50 000 subjects has shown a 20% reduction in mortality with CT. There are several other randomized trials in progress. CT scanning may be a useful technique for identifying lung cancer at an earlier stage and may reduce mortality. However, before it can be used on a wider scale, issues such as overdiagnosis bias, cost-effectiveness, false positive findings of multiple noncalcified nodules and the willingness of the relevant population to accept CT scanning need to be evaluated. There is still very little information on the cost per life-year saved as a result of CT scanning, as the data to date is very imprecise. There is no evidence that screening programs influence smoking rates despite the inclusion of cessation programs in many trials. Furthermore, if CT screening is adopted, much work is needed to persuade individuals at high risk, mostly current or former heavy smokers with some airflow obstruction, to participate in a screening program.