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Screening for lung cancer

Mark E Deffebach, MD
Linda Humphrey, MD
Section Editors
Joann G Elmore, MD, MPH
David E Midthun, MD
Deputy Editor
Judith A Melin, MA, MD, FACP


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 [1]. The promotion of smoking cessation is essential, as cigarette smoking is thought to be causal in 85 to 90 percent of all lung cancer [2]. 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 15 percent in 2015 [3], 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 [4-7].

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".)


Lung cancer is the leading cause of cancer-related death among men and women [8]. Some [9,10] but not all [11] studies suggest that, for any level of smoking, women are at higher risk of developing cancer than men. Worldwide, it is estimated that there are 1.6 million deaths due to lung cancer annually [12]. The American Cancer Society estimates over 220,000 new cases of lung cancer diagnosed yearly and over 150,000 lung cancer-associated deaths in the United States [13].

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) [14]. In addition, within early lung cancers (stage I), there is a relationship between tumor size and survival [15,16]. 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. However, 75 percent of patients with lung cancer present with symptoms due to advanced local or metastatic disease that is not amenable to cure [17]. Despite advances in therapy, five-year survival rates average approximately 18 percent for all individuals with lung cancer [18].


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 [19,20].

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Literature review current through: Nov 2017. | This topic last updated: Nov 09, 2017.
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  1. Fontham ET, Correa P, Reynolds P, et al. Environmental tobacco smoke and lung cancer in nonsmoking women. A multicenter study. JAMA 1994; 271:1752.
  2. Alberg AJ, Samet JM. Epidemiology of lung cancer. Chest 2003; 123:21S.
  3. Jamal A, King BA, Neff LJ, et al. Current Cigarette Smoking Among Adults - United States, 2005-2015. MMWR Morb Mortal Wkly Rep 2016; 65:1205.
  4. Burns DM. Primary prevention, smoking, and smoking cessation: implications for future trends in lung cancer prevention. Cancer 2000; 89:2506.
  5. Halpern MT, Khan ZM, Young TL, Battista C. Economic model of sustained-release bupropion hydrochloride in health plan and work site smoking-cessation programs. Am J Health Syst Pharm 2000; 57:1421.
  6. Halpern MT, Gillespie BW, Warner KE. Patterns of absolute risk of lung cancer mortality in former smokers. J Natl Cancer Inst 1993; 85:457.
  7. Tong L, Spitz MR, Fueger JJ, Amos CA. Lung carcinoma in former smokers. Cancer 1996; 78:1004.
  8. Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Dicker D, et al. The Global Burden of Cancer 2013. JAMA Oncol 2015; 1:505.
  9. McDuffie HH, Klaassen DJ, Dosman JA. Men, women and primary lung cancer--a Saskatchewan personal interview study. J Clin Epidemiol 1991; 44:537.
  10. Osann KE, Anton-Culver H, Kurosaki T, Taylor T. Sex differences in lung-cancer risk associated with cigarette smoking. Int J Cancer 1993; 54:44.
  11. Bain C, Feskanich D, Speizer FE, et al. Lung cancer rates in men and women with comparable histories of smoking. J Natl Cancer Inst 2004; 96:826.
  12. Stewart B, Wild CP. World Cancer Report 2014, 2014.
  13. American Cancer Society: Key statistics for lung cancer. http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-key-statistics (Accessed on October 11, 2017).
  14. Mountain CF. Revisions in the International System for Staging Lung Cancer. Chest 1997; 111:1710.
  15. Flieder DB, Port JL, Korst RJ, et al. Tumor size is a determinant of stage distribution in t1 non-small cell lung cancer. Chest 2005; 128:2304.
  16. Goldwasser DL. Estimation of the tumor size at cure threshold among aggressive non-small cell lung cancers (NSCLCs): evidence from the surveillance, epidemiology, and end results (SEER) program and the national lung screening trial (NLST). Int J Cancer 2017; 140:1280.
  17. Molina JR, Adjei AA, Jett JR. Advances in chemotherapy of non-small cell lung cancer. Chest 2006; 130:1211.
  18. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67:7.
  19. Cole P, Morrison AS. Basic issues in population screening for cancer. J Natl Cancer Inst 1980; 64:1263.
  20. Patz EF Jr, Goodman PC, Bepler G. Screening for lung cancer. N Engl J Med 2000; 343:1627.
  21. van der Aalst CM, van den Bergh KA, Willemsen MC, et al. Lung cancer screening and smoking abstinence: 2 year follow-up data from the Dutch-Belgian randomised controlled lung cancer screening trial. Thorax 2010; 65:600.
  22. van der Aalst CM, van Klaveren RJ, van den Bergh KA, et al. The impact of a lung cancer computed tomography screening result on smoking abstinence. Eur Respir J 2011; 37:1466.
  23. Brain K, Lifford KJ, Carter B, et al. Long-term psychosocial outcomes of low-dose CT screening: results of the UK Lung Cancer Screening randomised controlled trial. Thorax 2016; 71:996.
  24. Brain K, Carter B, Lifford KJ, et al. Impact of low-dose CT screening on smoking cessation among high-risk participants in the UK Lung Cancer Screening Trial. Thorax 2017; 72:912.
  25. Tammemägi MC, Berg CD, Riley TL, et al. Impact of lung cancer screening results on smoking cessation. J Natl Cancer Inst 2014; 106:dju084.
  26. Bach PB, Jett JR, Pastorino U, et al. Computed tomography screening and lung cancer outcomes. JAMA 2007; 297:953.
  27. Croswell JM, Baker SG, Marcus PM, et al. Cumulative incidence of false-positive test results in lung cancer screening: a randomized trial. Ann Intern Med 2010; 152:505.
  28. National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365:395.
  29. Kinsinger LS, Anderson C, Kim J, et al. Implementation of Lung Cancer Screening in the Veterans Health Administration. JAMA Intern Med 2017; 177:399.
  30. Brenner DJ. Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer. Radiology 2004; 231:440.
  31. Veronesi G, Maisonneuve P, Spaggiari L, et al. Diagnostic performance of low-dose computed tomography screening for lung cancer over five years. J Thorac Oncol 2014; 9:935.
  32. Rampinelli C, De Marco P, Origgi D, et al. Exposure to low dose computed tomography for lung cancer screening and risk of cancer: secondary analysis of trial data and risk-benefit analysis. BMJ 2017; 356:j347.
  33. Larke FJ, Kruger RL, Cagnon CH, et al. Estimated radiation dose associated with low-dose chest CT of average-size participants in the National Lung Screening Trial. AJR Am J Roentgenol 2011; 197:1165.
  34. Slatore CG, Sullivan DR, Pappas M, Humphrey LL. Patient-centered outcomes among lung cancer screening recipients with computed tomography: a systematic review. J Thorac Oncol 2014; 9:927.
  35. Gareen IF, Duan F, Greco EM, et al. Impact of lung cancer screening results on participant health-related quality of life and state anxiety in the National Lung Screening Trial. Cancer 2014; 120:3401.
  36. Woolf SH, Harris RP, Campos-Outcalt D. Low-dose computed tomography screening for lung cancer: how strong is the evidence? JAMA Intern Med 2014; 174:2019.
  37. Reich JM. A critical appraisal of overdiagnosis: estimates of its magnitude and implications for lung cancer screening. Thorax 2008; 63:377.
  38. Sone S, Nakayama T, Honda T, et al. Long-term follow-up study of a population-based 1996-1998 mass screening programme for lung cancer using mobile low-dose spiral computed tomography. Lung Cancer 2007; 58:329.
  39. Lindell RM, Hartman TE, Swensen SJ, et al. Five-year lung cancer screening experience: CT appearance, growth rate, location, and histologic features of 61 lung cancers. Radiology 2007; 242:555.
  40. Patz EF Jr, Pinsky P, Gatsonis C, et al. Overdiagnosis in low-dose computed tomography screening for lung cancer. JAMA Intern Med 2014; 174:269.
  41. Couraud S, Greillier L, Milleron B, IFCT Lung Cancer Screening Group. Estimating overdiagnosis in lung cancer screening. JAMA Intern Med 2014; 174:1197.
  42. Gelbman BD, Libby DM. Estimating overdiagnosis in lung cancer screening. JAMA Intern Med 2014; 174:1197.
  43. Berlin NI, Buncher CR, Fontana RS, et al. The National Cancer Institute Cooperative Early Lung Cancer Detection Program. Results of the initial screen (prevalence). Early lung cancer detection: Introduction. Am Rev Respir Dis 1984; 130:545.
  44. Brett GZ. The value of lung cancer detection by six-monthly chest radiographs. Thorax 1968; 23:414.
  45. Brett GZ. Earlier diagnosis and survival in lung cancer. Br Med J 1969; 4:260.
  46. Dales LG, Friedman GD, Collen MF. Evaluating periodic multiphasic health checkups: a controlled trial. J Chronic Dis 1979; 32:385.
  47. Flehinger BJ, Kimmel M, Polyak T, Melamed MR. Screening for lung cancer. The Mayo Lung Project revisited. Cancer 1993; 72:1573.
  48. Fontana RS, Sanderson DR, Taylor WF, et al. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo Clinic study. Am Rev Respir Dis 1984; 130:561.
  49. Friedman GD, Collen MF, Fireman BH. Multiphasic Health Checkup Evaluation: a 16-year follow-up. J Chronic Dis 1986; 39:453.
  50. Frost JK, Ball WC Jr, Levin ML, et al. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Johns Hopkins study. Am Rev Respir Dis 1984; 130:549.
  51. Kubik A, Parkin DM, Khlat M, et al. Lack of benefit from semi-annual screening for cancer of the lung: follow-up report of a randomized controlled trial on a population of high-risk males in Czechoslovakia. Int J Cancer 1990; 45:26.
  52. Kubík A, Polák J. Lung cancer detection. Results of a randomized prospective study in Czechoslovakia. Cancer 1986; 57:2427.
  53. Kubík AK, Parkin DM, Zatloukal P. Czech Study on Lung Cancer Screening: post-trial follow-up of lung cancer deaths up to year 15 since enrollment. Cancer 2000; 89:2363.
  54. Marcus PM, Bergstralh EJ, Fagerstrom RM, et al. Lung cancer mortality in the Mayo Lung Project: impact of extended follow-up. J Natl Cancer Inst 2000; 92:1308.
  55. Melamed MR. Lung cancer screening results in the National Cancer Institute New York study. Cancer 2000; 89:2356.
  56. Melamed MR, Flehinger BJ, Zaman MB, et al. Screening for early lung cancer. Results of the Memorial Sloan-Kettering study in New York. Chest 1984; 86:44.
  57. Stitik FP, Tockman MS. Radiographic screening in the early detection of lung cancer. Radiol Clin North Am 1978; 16:347.
  58. Wilde J. A 10 year follow-up of semi-annual screening for early detection of lung cancer in the Erfurt County, GDR. Eur Respir J 1989; 2:656.
  59. U.S. Preventive Services Task Force. Lung cancer screening: recommendation statement. Ann Intern Med 2004; 140:738.
  60. Marcus PM, Bergstralh EJ, Zweig MH, et al. Extended lung cancer incidence follow-up in the Mayo Lung Project and overdiagnosis. J Natl Cancer Inst 2006; 98:748.
  61. Manser R, Lethaby A, Irving LB, et al. Screening for lung cancer. Cochrane Database Syst Rev 2013; :CD001991.
  62. Prorok PC, Andriole GL, Bresalier RS, et al. Design of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Control Clin Trials 2000; 21:273S.
  63. Oken MM, Marcus PM, Hu P, et al. Baseline chest radiograph for lung cancer detection in the randomized Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. J Natl Cancer Inst 2005; 97:1832.
  64. Oken MM, Hocking WG, Kvale PA, et al. Screening by chest radiograph and lung cancer mortality: the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized trial. JAMA 2011; 306:1865.
  65. Ebeling K, Nischan P. Screening for lung cancer--results from a case-control study. Int J Cancer 1987; 40:141.
  66. Nishii K, Ueoka H, Kiura K, et al. A case-control study of lung cancer screening in Okayama Prefecture, Japan. Lung Cancer 2001; 34:325.
  67. Okamoto N, Suzuki T, Hasegawa H, et al. Evaluation of a clinic-based screening program for lung cancer with a case-control design in Kanagawa, Japan. Lung Cancer 1999; 25:77.
  68. Sagawa M, Tsubono Y, Saito Y, et al. A case-control study for evaluating the efficacy of mass screening program for lung cancer in Miyagi Prefecture, Japan. Cancer 2001; 92:588.
  69. Sobue T. A case-control study for evaluating lung cancer screening in Japan. Cancer 2000; 89:2392.
  70. Sobue T, Suzuki T, Naruke T. Efficacy of lung cancer screening; comparison of results from a case-control study and a survival analysis. The Japanese Lung Cancer Screening Research Group. Jpn J Cancer Res 1992; 83:424.
  71. Tsukada H, Kurita Y, Yokoyama A, et al. An evaluation of screening for lung cancer in Niigata Prefecture, Japan: a population-based case-control study. Br J Cancer 2001; 85:1326.
  72. Black WC. Computed tomography screening for lung cancer: review of screening principles and update on current status. Cancer 2007; 110:2370.
  73. Bach PB, Mirkin JN, Oliver TK, et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA 2012; 307:2418.
  74. Humphrey LL, Deffebach M, Pappas M, et al. Screening for lung cancer with low-dose computed tomography: a systematic review to update the US Preventive services task force recommendation. Ann Intern Med 2013; 159:411.
  75. Henschke CI, McCauley DI, Yankelevitz DF, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999; 354:99.
  76. Henschke CI, Yankelevitz DF, Libby DM, et al. Early lung cancer action project: annual screening using single-slice helical CT. Ann N Y Acad Sci 2001; 952:124.
  77. International Early Lung Cancer Action Program Investigators, Henschke CI, Yankelevitz DF, et al. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 2006; 355:1763.
  78. Swensen SJ, Jett JR, Hartman TE, et al. CT screening for lung cancer: five-year prospective experience. Radiology 2005; 235:259.
  79. 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.
  80. Swensen SJ, Jett JR, Hartman TE, et al. Lung cancer screening with CT: Mayo Clinic experience. Radiology 2003; 226:756.
  81. McMahon PM, Kong CY, Johnson BE, et al. Estimating long-term effectiveness of lung cancer screening in the Mayo CT screening study. Radiology 2008; 248:278.
  82. Gohagan J, Marcus P, Fagerstrom R, et al. Baseline findings of a randomized feasibility trial of lung cancer screening with spiral CT scan vs chest radiograph: the Lung Screening Study of the National Cancer Institute. Chest 2004; 126:114.
  83. National Lung Screening Trial Research Team, Aberle DR, Berg CD, et al. The National Lung Screening Trial: overview and study design. Radiology 2011; 258:243.
  84. National Lung Screening Trial Research Team, Church TR, Black WC, et al. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med 2013; 368:1980.
  85. Patz EF Jr, Greco E, Gatsonis C, et al. Lung cancer incidence and mortality in National Lung Screening Trial participants who underwent low-dose CT prevalence screening: a retrospective cohort analysis of a randomised, multicentre, diagnostic screening trial. Lancet Oncol 2016; 17:590.
  86. Aberle DR, DeMello S, Berg CD, et al. Results of the two incidence screenings in the National Lung Screening Trial. N Engl J Med 2013; 369:920.
  87. Silvestri GA. Screening for lung cancer: it works, but does it really work? Ann Intern Med 2011; 155:537.
  88. National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365:395.
  89. Field JK, van Klaveren R, Pedersen JH, et al. European randomized lung cancer screening trials: Post NLST. J Surg Oncol 2013; 108:280.
  90. van Iersel CA, de Koning HJ, Draisma G, et al. Risk-based selection from the general population in a screening trial: selection criteria, recruitment and power for the Dutch-Belgian randomised lung cancer multi-slice CT screening trial (NELSON). Int J Cancer 2007; 120:868.
  91. Horeweg N, Scholten ET, de Jong PA, et al. Detection of lung cancer through low-dose CT screening (NELSON): a prespecified analysis of screening test performance and interval cancers. Lancet Oncol 2014; 15:1342.
  92. Yousaf-Khan U, van der Aalst C, de Jong PA, et al. Final screening round of the NELSON lung cancer screening trial: the effect of a 2.5-year screening interval. Thorax 2017; 72:48.
  93. Walter JE, Heuvelmans MA, de Jong PA, et al. Occurrence and lung cancer probability of new solid nodules at incidence screening with low-dose CT: analysis of data from the randomised, controlled NELSON trial. Lancet Oncol 2016; 17:907.
  94. Infante M, Brambilla G, Lutman F, et al. DANTE: a randomized trial on lung cancer screening with low-dose sprial CT (LDCT): initial announcement. Chest 2003; 124:118S.
  95. Infante M, Cavuto S, Lutman FR, et al. Long-Term Follow-up Results of the DANTE Trial, a Randomized Study of Lung Cancer Screening with Spiral Computed Tomography. Am J Respir Crit Care Med 2015; 191:1166.
  96. Pedersen JH, Ashraf H, Dirksen A, et al. The Danish randomized lung cancer CT screening trial--overall design and results of the prevalence round. J Thorac Oncol 2009; 4:608.
  97. Saghir Z, Dirksen A, Ashraf H, et al. CT screening for lung cancer brings forward early disease. The randomised Danish Lung Cancer Screening Trial: status after five annual screening rounds with low-dose CT. Thorax 2012; 67:296.
  98. Wille MM, Dirksen A, Ashraf H, et al. Results of the Randomized Danish Lung Cancer Screening Trial with Focus on High-Risk Profiling. Am J Respir Crit Care Med 2016; 193:542.
  99. Pastorino U, Rossi M, Rosato V, et al. Annual or biennial CT screening versus observation in heavy smokers: 5-year results of the MILD trial. Eur J Cancer Prev 2012; 21:308.
  100. Becker N, Motsch E, Gross ML, et al. Randomized Study on Early Detection of Lung Cancer with MSCT in Germany: Results of the First 3 Years of Follow-up After Randomization. J Thorac Oncol 2015; 10:890.
  101. Field JK, Duffy SW, Baldwin DR, et al. UK Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening. Thorax 2016; 71:161.
  102. Bach PB, Gould MK. When the average applies to no one: personalized decision making about potential benefits of lung cancer screening. Ann Intern Med 2012; 157:571.
  103. Ma J, Ward EM, Smith R, Jemal A. Annual number of lung cancer deaths potentially avertable by screening in the United States. Cancer 2013; 119:1381.
  104. Howard DH, Richards TB, Bach PB, et al. Comorbidities, smoking status, and life expectancy among individuals eligible for lung cancer screening. Cancer 2015; 121:4341.
  105. Tammemagi MC, Lam S. Screening for lung cancer using low dose computed tomography. BMJ 2014; 348:g2253.
  106. Kanodra NM, Silvestri GA, Tanner NT. Screening and early detection efforts in lung cancer. Cancer 2015; 121:1347.
  107. Caverly T. Selecting the best candidates for lung cancer screening. JAMA Intern Med 2015; 175:898.
  108. Gould MK. Clinical practice. Lung-cancer screening with low-dose computed tomography. N Engl J Med 2014; 371:1813.
  109. Pinsky PF, Gierada DS, Hocking W, et al. National Lung Screening Trial findings by age: Medicare-eligible versus under-65 population. Ann Intern Med 2014; 161:627.
  110. Henschke CI, Yip R, Yankelevitz DF, et al. Definition of a positive test result in computed tomography screening for lung cancer: a cohort study. Ann Intern Med 2013; 158:246.
  111. Yip R, Henschke CI, Yankelevitz DF, Smith JP. CT screening for lung cancer: alternative definitions of positive test result based on the national lung screening trial and international early lung cancer action program databases. Radiology 2014; 273:591.
  112. Pinsky PF, Gierada DS, Black W, et al. Performance of Lung-RADS in the National Lung Screening Trial: a retrospective assessment. Ann Intern Med 2015; 162:485.
  113. Lam S, McWilliams A, Mayo J, Tammemagi M. Computed tomography screening for lung cancer: what is a positive screen? Ann Intern Med 2013; 158:289.
  114. McWilliams A, Tammemagi MC, Mayo JR, et al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med 2013; 369:910.
  115. Katki HA, Kovalchik SA, Berg CD, et al. Development and Validation of Risk Models to Select Ever-Smokers for CT Lung Cancer Screening. JAMA 2016; 315:2300.
  116. Raji OY, Duffy SW, Agbaje OF, et al. Predictive accuracy of the Liverpool Lung Project risk model for stratifying patients for computed tomography screening for lung cancer: a case-control and cohort validation study. Ann Intern Med 2012; 157:242.
  117. Cronin KA, Gail MH, Zou Z, et al. Validation of a model of lung cancer risk prediction among smokers. J Natl Cancer Inst 2006; 98:637.
  118. Etzel CJ, Bach PB. Estimating individual risk for lung cancer. Semin Respir Crit Care Med 2011; 32:3.
  119. Spitz MR, Hong WK, Amos CI, et al. A risk model for prediction of lung cancer. J Natl Cancer Inst 2007; 99:715.
  120. Tammemagi CM, Pinsky PF, Caporaso NE, et al. Lung cancer risk prediction: Prostate, Lung, Colorectal And Ovarian Cancer Screening Trial models and validation. J Natl Cancer Inst 2011; 103:1058.
  121. Lowry KP, Gazelle GS, Gilmore ME, et al. Personalizing annual lung cancer screening for patients with chronic obstructive pulmonary disease: A decision analysis. Cancer 2015; 121:1556.
  122. Kovalchik SA, Tammemagi M, Berg CD, et al. Targeting of low-dose CT screening according to the risk of lung-cancer death. N Engl J Med 2013; 369:245.
  123. Tammemägi MC, Katki HA, Hocking WG, et al. Selection criteria for lung-cancer screening. N Engl J Med 2013; 368:728.
  124. Tammemägi MC, Church TR, Hocking WG, et al. Evaluation of the lung cancer risks at which to screen ever- and never-smokers: screening rules applied to the PLCO and NLST cohorts. PLoS Med 2014; 11:e1001764.
  125. McMahon PM, Kong CY, Bouzan C, et al. Cost-effectiveness of computed tomography screening for lung cancer in the United States. J Thorac Oncol 2011; 6:1841.
  126. Black WC, Gareen IF, Soneji SS, et al. Cost-effectiveness of CT screening in the National Lung Screening Trial. N Engl J Med 2014; 371:1793.
  127. Jaklitsch MT, Jacobson FL, Austin JH, et al. The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg 2012; 144:33.
  128. Detterbeck FC, Mazzone PJ, Naidich DP, Bach PB. Screening for lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e78S.
  129. Wender R, Fontham ET, Barrera E Jr, et al. American Cancer Society lung cancer screening guidelines. CA Cancer J Clin 2013; 63:107.
  130. Canadian Task Force on Preventive Health Care, Lewin G, Morissette K, et al. Recommendations on screening for lung cancer. CMAJ 2016; 188:425.
  131. Wood DE. National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Lung Cancer Screening. Thorac Surg Clin 2015; 25:185.
  132. U.S. Preventive Services Task Force Recommendation Statement: Screening for Lung Cancer http://www.uspreventiveservicestaskforce.org/uspstf13/lungcan/lungcanfinalrs.htm (Accessed on January 03, 2014).
  133. de Koning HJ, Meza R, Plevritis SK, et al. Benefits and harms of computed tomography lung cancer screening strategies: a comparative modeling study for the U.S. Preventive Services Task Force. Ann Intern Med 2014; 160:311.
  134. Couraud S, Cortot AB, Greillier L, et al. From randomized trials to the clinic: is it time to implement individual lung-cancer screening in clinical practice? A multidisciplinary statement from French experts on behalf of the French intergroup (IFCT) and the groupe d'Oncologie de langue francaise (GOLF). Ann Oncol 2013; 24:586.
  135. Roberts H, Walker-Dilks C, Sivjee K, et al. Screening high-risk populations for lung cancer: guideline recommendations. J Thorac Oncol 2013; 8:1232.
  136. Wood DE. The importance of lung cancer screening with low-dose computed tomography for Medicare beneficiaries. JAMA Intern Med 2014; 174:2016.
  137. Chin J, Syrek Jensen T, Ashby L, et al. Screening for lung cancer with low-dose CT--translating science into Medicare coverage policy. N Engl J Med 2015; 372:2083.
  138. Mulshine JL, D'Amico TA. Issues with implementing a high-quality lung cancer screening program. CA Cancer J Clin 2014; 64:352.
  139. Armstrong K, Kim JJ, Halm EA, et al. Using lessons from breast, cervical, and colorectal cancer screening to inform the development of lung cancer screening programs. Cancer 2016; 122:1338.
  140. Woloshin S, Schwartz LM, Black WC, Kramer BS. Cancer screening campaigns--getting past uninformative persuasion. N Engl J Med 2012; 367:1677.
  141. Decision Memo for Screening for Lung Cancer with Low Dose Computed Tomography (LDCT). http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274 (Accessed on April 02, 2015).
  142. Pastorino U, Bellomi M, Landoni C, et al. Early lung-cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results. Lancet 2003; 362:593.
  143. Bastarrika G, García-Velloso MJ, Lozano MD, et al. Early lung cancer detection using spiral computed tomography and positron emission tomography. Am J Respir Crit Care Med 2005; 171:1378.
  144. Mulshine JL, Tockman MS, Smart CR. Considerations in the development of lung cancer screening tools. J Natl Cancer Inst 1989; 81:900.
  145. Hensing TA, Salgia R. Molecular biomarkers for future screening of lung cancer. J Surg Oncol 2013; 108:327.
  146. Belinsky SA, Liechty KC, Gentry FD, et al. Promoter hypermethylation of multiple genes in sputum precedes lung cancer incidence in a high-risk cohort. Cancer Res 2006; 66:3338.
  147. Kersting M, Friedl C, Kraus A, et al. Differential frequencies of p16(INK4a) promoter hypermethylation, p53 mutation, and K-ras mutation in exfoliative material mark the development of lung cancer in symptomatic chronic smokers. J Clin Oncol 2000; 18:3221.
  148. Mulshine JL, Scott F. Molecular markers in early cancer detection. New screening tools. Chest 1995; 107:280S.
  149. Ahrendt SA, Chow JT, Xu LH, et al. Molecular detection of tumor cells in bronchoalveolar lavage fluid from patients with early stage lung cancer. J Natl Cancer Inst 1999; 91:332.
  150. Baryshnikova E, Destro A, Infante MV, et al. Molecular alterations in spontaneous sputum of cancer-free heavy smokers: results from a large screening program. Clin Cancer Res 2008; 14:1913.
  151. Henschke CI. Medicine on lung cancer screening: a different paradigm. Am J Respir Crit Care Med 2003; 168:1143.
  152. George PJ. Fluorescence bronchoscopy for the early detection of lung cancer. Thorax 1999; 54:180.
  153. Hirsch FR, Prindiville SA, Miller YE, et al. Fluorescence versus white-light bronchoscopy for detection of preneoplastic lesions: a randomized study. J Natl Cancer Inst 2001; 93:1385.
  154. Phillips M, Gleeson K, Hughes JM, et al. Volatile organic compounds in breath as markers of lung cancer: a cross-sectional study. Lancet 1999; 353:1930.
  155. Phillips M, Cataneo RN, Cummin AR, et al. Detection of lung cancer with volatile markers in the breath. Chest 2003; 123:2115.
  156. Machado RF, Laskowski D, Deffenderfer O, et al. Detection of lung cancer by sensor array analyses of exhaled breath. Am J Respir Crit Care Med 2005; 171:1286.
  157. Petty RD, Nicolson MC, Kerr KM, et al. Gene expression profiling in non-small cell lung cancer: from molecular mechanisms to clinical application. Clin Cancer Res 2004; 10:3237.
  158. Rahman SM, Shyr Y, Yildiz PB, et al. Proteomic patterns of preinvasive bronchial lesions. Am J Respir Crit Care Med 2005; 172:1556.
  159. Zhong L, Hidalgo GE, Stromberg AJ, et al. Using protein microarray as a diagnostic assay for non-small cell lung cancer. Am J Respir Crit Care Med 2005; 172:1308.
  160. Veronesi G, Maisonneuve P, Bellomi M, et al. Estimating overdiagnosis in low-dose computed tomography screening for lung cancer: a cohort study. Ann Intern Med 2012; 157:776.