Should we screen for lung cancer in Australia?
Systematic screening reduces mortality, but is it the best way to go?
Lung cancer is the leading cause of cancer death in Australia. Late diagnosis of advanced disease contributes to the poor 13% 5-year survival rate associated with lung cancer. However, the recently updated United States National Lung Screening Trial (NLST) showed a 20% survival benefit from early detection with low-dose computed tomography (CT) screening.1,2 In light of these results, should people in Australia at high risk of lung cancer now undergo screening?
The NLST randomly allocated 53 000 participants to three rounds of annual screening with either chest CT or chest x-ray, with follow-up for a further 3 years.1,2 Unlike population-based screening programs for other common cancers, the NLST only enrolled high-risk participants (ie, current smokers or former smokers who had quit within the past 15 years, aged between 54 and 74 years, with > 30 pack-years). Adherence to screening was over 90%. At the initial screen, three times more stage…