Lynn T. Tanoue


Curr Opin Pulm Med. 2016;22(4):327-335. 

In This Article


Large trials in the 1970s and 1980s evaluating chest radiography (CXR) and sputum cytology as lung cancer screening interventions failed to demonstrate any mortality benefit, though in retrospect they were insufficiently powered to do so.[7–10] The ineffectiveness of CXR in screening was convincingly demonstrated by the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO).[11] The PLCO randomized lung cancer screening participants to either annual CXR or no screening; the study definitively confirmed the absence of any mortality benefit associated with CXR screening. The concept of screening with computed tomography (CT) was raised in the 1990s, as technological advances allowed the acquisition of images with sufficient quality using lower doses of radiation than necessary for diagnostic chest CTs. Several single arm studies demonstrated that screening with low-dose chest CT (LDCT) was feasible, reproducible, and identified an increased number of early-stage lung cancers.[12,13] These uncontrolled studies recognized that LDCT screening yields a very high rate of false-positive findings, predominantly small pulmonary nodules, and raised serious concern for overdiagnosis bias.[14,15]