Abstract

Lung cancer screening has been for many years a topic of controversy and complexity which is confusing even to experts in the fields of pulmonary medicine and oncology. On the one hand, lung cancer is by far the most devastating cancer killer in the world and we have made little progress in treating it once it reaches advanced stages, making the idea of an effective screening tool extremely appealing. Conversely, no professional society has yet recommended screening for lung cancer in any situation, for the simple reason that all clinical studies have uniformly failed to show a mortality benefit from screening. Our eagerness to establish an effective screening program and the repeated failures in this regard have made the issue an intellectual and emotional morass. New publications dealing with lung cancer screening are met with hope, but also with pessimistic skepticism. This recently occurred again with the publication of two large studies looking at screening with serial computed tomography (CT) of the chest, one suggesting possible benefit to screening and one confirming results of past studies in finding no clear benefit. While more data are always welcome in this difficult arena, these studies have served to re-enliven the debate and may have made the question even more confusing to clinicians dealing with the question of screening in our clinical practices. In their review article published last month in The Cleveland Clinic Journal of Medicine, Mazzone et al¹ have provided a thorough and extremely readable summary of the challenges inherent in screening research, lung cancer screening, and interpreting the two new studies in the context of our current position. Our purpose in this commentary is not to summarize Mazzone’s discussion, but rather to explain why this review is a particularly helpful article for any practitioner struggling to understand lung cancer screening and the newly published evidence.