memo - Magazine of European Medical Oncology | 2019
Saving lives with lung cancer screening
Abstract
Lung cancer is the number one reason for cancer-related death in Austria and many other countries, especially due the fact that the majority of patients are diagnosed at an advanced stage of the disease. Two large trials (NLST and NELSON) proved the efficacy of low-dose CT (LD-CT) for lung cancer screening [1, 2]. Lung cancer deaths were decreased and early diagnosis facilitated curative treatment options. Thus, the risk to die from lung cancer was reduced by 26% in the NELSON trial. These two large trials applied age and smoking history to define the screening population. However, adding additional factors resulting in a multivariable lung cancer risk prediction model, as discussed by Asshoff et al. [4], showed a significant better performance than the criteria used in the NLST. The perspective of the radiologist is discussed by G. Widmann [5]. Criteria of a board certification and expertise in lung nodule reporting systems including volume measurement are essential to reduce falsepositive results. Furthermore the implementation of a national accreditation program is recommended to guarantee nationwide equal standards and quality of screening. He pointed out the necessity of a low effective radiation dose of <1.6mSv, which is lower than the natural background radiation. This must be balanced with having to deal with 4%major complications from cytology and needle biopsy asking for a critical ap-