Screening for lung cancer

Abstract

The lethality of lung cancer is related to the advanced stage at diagnosis. Initial studies have demonstrated that screening computed tomography (CT) is effective in diagnosing lung cancer at an earlier stage when compared with current clinical practice, however the best clinical approach for screening detected nodules has to be defined. The population to be identified as high risk should be over 50 years of age and should have smoked at least one pack/day for 20 years. CT protocols should use multidetector CT, low dose and a 2.5 reconstruction interval. Diagnostic workup on detected nodules should be designed according to size and consider CT at 3 or 12 months to evaluate doubling time, CT enhancement, PET/CT and/or FNAB or VATS. The prevalence of lung cancer in the screened population is 1.1%-2.7%, and the incidence is 0.2%-1.1%. Eighty-one percent of cancers are diagnosed in stage I. The percentage of surgery performed for benign lesions ranges from 21% to 55%. In our series, the overall mortality rate was 3.2% in 5 years. The results of randomized clinical studies, when available, will assess the real efficacy of CT in reducing lung cancer related mortality.

Figure 1

Protocol for the management of lung nodules.