[The need of lung cancer screening: new evidence, new expectations]

Abstract

Lung cancer is the most common cancer in Poland and in the world and the leading cause of cancer-related deaths. In the past 30 years lung cancer survival has not been improved. In the same period of time significant progress has been made in the results of treatment of many other cancers for example: breast, colorectal and prostate cancer. It may be connected with introduction of efficient screening tests. Lung cancer seems to be a disease for which screening could have great impact. In the 1970s trials evaluating chest roentgenograms and sputum cytology as screening modalities were conducted, but did not show reduction in lung cancer mortality. There have been several projects in which low-dose helical computed tomography was used. Many of them were non-randomized cohort studies and showed promising results with respect to sensitivity of computed tomography, but the real benefit, which is mortality reduction, must originate from randomized trials. The major breakthrough is the National Lung Screening Trial (NLST), randomized trial conducted in USA, that demonstrated 20% mortality reduction in low-dose computed tomography group comparing to radiography group. Several randomized trials are ongoing in Europe. Researchers continue to seek new methods of screening such as autofluorescence bronchoscopy, advanced techniques of sputum analysis and techniques of molecular biology.