Q: Screening for early-stage lung cancer is not recommended by the
National Cancer Institute (NCI) or the American Cancer Society (ACS).
Why, then, should I consider it for my patients who are current or former
A: Approximately 90% of cases of lung cancer are attributable to smoking—
either directly or as a result of passive exposure. Fifty percent of smokers
die of a smoking-related disease. The 4 most common causes of death—heart
attack, lung cancer, chronic obstructive pulmonary disease, and stroke—are
all associated with smoking. More lung cancer is diagnosed in former than in
current smokers.1 The risk of lung cancer decreases each year following smoking
cessation, but former heavy smokers will always have a higher risk than
Other lung cancer risks include exposure to industrial chemicals (particularly
asbestos), solvents, certain heavy metals and, possibly, radon. But if it
were not for tobacco use, lung cancer would be a rare disease instead of what
it is today—the most common fatal malignancy in both men and women.
This year, approximately 175,000 new lung cancers will be diagnosed, mostly
in advanced and symptomatic stages. Only about 13% of patients will be alive
5 years after diagnosis.2 The reason for this dismal statistic is the lack of any
systematic early detection program, even for persons known to be at high risk.
Deaths from lung cancer among men are now falling slightly, but the numbers
are increasing rapidly in women. The net result is a continuing rise in lung cancer
The case for screening. Neither the NCI nor the ACS recommends screening
for early-stage lung cancer3—a position that I oppose. I have made a strong
case for lung cancer screening in high-risk groups.4 Solid evidence exists that in
the population of persons with a history of heavy smoking and airflow obstruction
as determined by simple spirometry, the prevalence of lung cancer is 3%
to 5% during the 5 years after initial screening. This is a very large number compared
with the much lower yield of screening programs for breast, prostate,
and colon cancers. Early-stage lung cancer has a prognosis comparable to that of
other early-stage cancers.5 Thus, early detection is the only way to improve
Today we have the knowledge and technology to detect lung cancer in the
early, asymptomatic stages when improved survival and the likelihood of cure
are high. Low-dose CT scanning for peripheral lesions and sputum cytology for
central lesions can identify most of these cancers. It is time to implement screening
programs for high-risk patients. We do not need controlled clinical trials to
verify that we can find, treat, and cure lung cancer right now.
1. Burns DM. Primary prevention, smoking, and smoking cessation: implications for future trends in lung
cancer prevention. Cancer. 2000;89(suppl 11):2506-2509.
2. Swensen SJ, Jett JR, Sloan JA, et al. Screening for lung cancer with low-dose spiral computed tomography.
Am J Respir Crit Care Med. 2002;165:508-513.
3. Smith RA, Cokkinides V, von Eschenbach AC, et al. American Cancer Society guidelines for the early
detection of cancer. CA Cancer J Clin. 2002;52:8-22.
4. Petty TL. The early diagnosis of lung cancer. Dis Mon. 2001;47:204-264.
5. Mountain CF. Lung Cancer: A Handbook for Staging, Imaging, and Lymph Node Classification. Austin:
University of Texas Press; 1999.