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Screening for lung cancer

Authors
Mark E Deffebach, MD
Linda Humphrey, MD
Section Editors
Joann G Elmore, MD, MPH
David E Midthun, MD
Deputy Editor
Sadhna R Vora, MD

INTRODUCTION

Lung cancer is the leading cause of cancer-related death among men and women [1]. Some [2,3], but not all [4], studies suggest that for any level of smoking, women are at higher risk of developing cancer than men. In the year 2016, the American Cancer Society predicts that there will be approximately 224,000 new cases of lung cancer diagnosed, and approximately 158,000 lung cancer-associated deaths in the United States [5]. Worldwide, it is estimated that there were 1.59 million deaths in the year 2012 [6].

Unfortunately, 75 percent of patients with lung cancer present with symptoms due to advanced local or metastatic disease that is not amenable to cure [7]. Despite advances in therapy, five-year survival rates average approximately 16 percent for all individuals with lung cancer [8].

Prevention, rather than screening, is the most effective strategy for reducing the burden of lung cancer in the long term. Most lung cancer is attributed to smoking, including lung cancer in nonsmokers in whom a significant proportion of cancer is attributed to environmental smoke exposure [9]. The promotion of smoking cessation is essential, as cigarette smoking is thought to be causal in 85 to 90 percent of all lung cancer [10]. Progress in smoking cessation is now reflected in declining lung cancer rates and mortality in men in the United States. However, the smoking rate in the United States remains high, at 19 percent in 2011 [11], and is increasing in many parts of the world. In addition, a high percentage of lung cancer occurs in former smokers since the risk for lung cancer does not decline for many years following smoking cessation [12-15].

Screening for lung cancer will be reviewed here. General principles of screening, risk factors associated with the development of lung cancer, and techniques for smoking cessation are discussed separately. (See "Evidence-based approach to prevention" and "Overview of smoking cessation management in adults" and "Cigarette smoking and other possible risk factors for lung cancer".)

POTENTIAL BENEFITS OF SCREENING

Many characteristics of lung cancer suggest that screening should be effective: high morbidity and mortality, significant prevalence (0.5 to 2.2 percent), identified risk factors allowing targeted screening for high-risk individuals, a lengthy preclinical phase for some types of lung cancer, and evidence that therapy is more effective in early-stage disease [16,17]. Clinical outcome for non-small cell lung cancer is directly related to stage at the time of diagnosis, ranging from over 60 percent five-year survival for stage I disease, to less than 5 percent for stage IV disease (table 1 and figure 1) [18]. In addition, within early lung cancers (stage I), there is a relationship between tumor size and survival [19]. Available data are more limited for patients with small cell lung cancer but also support an improved outcome when disease is diagnosed at an early stage.

               

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