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Screening for lung cancer: it works, but does it really work?

Authors
  • Silvestri, Gerard A
Type
Published Article
Journal
Annals of Internal Medicine
Publisher
American College of Physicians
Publication Date
Oct 18, 2011
Volume
155
Issue
8
Pages
537–539
Identifiers
DOI: 10.7326/0003-4819-155-8-201110180-00364
PMID: 21893614
Source
Medline
License
Unknown

Abstract

After the publication of the NLST (National Lung Screening Trial) results, physicians will be faced with whether to begin ordering low-dose computed tomography (LDCT) of the chest to screen for lung cancer in patients with a history of tobacco use. Despite the encouraging reduction in deaths observed by using LDCT in the NLST study population, recommending adoption of lung cancer screening in general practice is premature. Lessons learned from prostate and breast cancer screening should remind us that the reductions in deaths expected with screening are unfortunately not as readily achievable as initially believed. Furthermore, the potential harms of false-positive findings on chest computed tomography are very real. The morbidity and even mortality associated with invasive diagnostic testing and surgical resection due to false- and true-positive findings on computed tomography are likely to increase when the approach taken in the NLST is applied in non-specialty care settings and among the population at highest risk, namely, those with smoking-related comorbid conditions. Although the NLST results are perhaps encouraging, they do not tell us enough that we can be sure that patients who undergo LDCT in an attempt to find early-stage lung cancer will have more benefit than harm.

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