Screening for lung cancer? What is the current status?

Kurzfassung:

Lung cancer is among the most frequent cancers worldwide with a mean 5-year survival below 20%. Smoking is the leading risk factor. In the past, chest radiografy and sputum have been investigated as screening tools, but negative results were obtained from randomized trials. In the following, randomized controlled trials were initiated to prove that CT screening is capable to reduce lung cancer mortality in heavy smokers. The largest trial, the „National Lung Screening Trial“ in the U.S. with 53454 participants (55 – 74 years old), demonstrated a significant reduction of lung cancer mortality in the CT arm. This was not confirmed by the final results from some smaller European trials. Together with ongoing trials 37000 subjects are enrolled in Europe. Pooled mortality data will be available in 2016. The overall evidence for CT lung screening is still weak, e.g. with regard to age range, gender, ethnicity, smoking habits. Measures to increase pretest probability such as additional risk factors have to be implemented and risk models should be used. False positive screen results, complications during further work-up and radiation exposure need to be reduced. The relevance of the overdiagnosis bias as well as the adequate intervals of CT screening have to be determined. Future CT lung screening has to be embedded in a comprehensive program with smoking cessation counselling and clear definitions of screening intervals, protocol, positive screens and appropriate work-up, as well as certification of interdisciplinary screening centres. On top of this the scope should be extended beyond the detection of nodules to a comprehensive risk assessment of smokers, including among others emphysema, obstructive airway disease, vascular disease.

Lernziele:

To learn about the limited evidence for lung cancer screening using CT To understand the specific German regulatory requirements for CT screening To appreciate the suggestions for comprehensive screening for smoking-induced diseases