The following consensus statement was developed by over 30
researchers meeting in Varese, Italy, in December 1998.
We are in the midst of a global and growing lung cancer epidemic. On
a worldwide basis, lung cancer is the most deadly malignancy; it will
cause more that one million deaths this year. Because cigarette
smoking is the vastly predominant cause, lung cancer is almost
entirely preventable. Other sources of risk include environmental
exposures and inherited risk.
Accordingly, the only currently effective means of prevention is to
refrain from smoking. For children and adolescents, the focus should
be on not starting smoking. For adults, smoking cessation is an
effective method of reducing lung cancer risk, but this is often
difficult to implement and achieve. It is important to recognize
their continuing risk: even after quitting, long-term smokers remain
at high risk for prolonged periods. There is a pressing need for
effective secondary prevention (screening) measures.
The conference reviewed available evidence relative to early
diagnosis of lung cancer. The pioneering studies have not shown
mortality reductions, and have led many organizations to recommend
against lung cancer screening. However, there are a number of
limitations to these studies, leaving us with an imperfect basis for
health policy. Paradoxically, case-finding studies show favorable
outcomes when lung cancer is detected early. Furthermore, over the
last 20 years, the pattern of disease has changed: conventional
diagnostic techniques have improved, and new early detection
techniques have emerged.
An important aspect of the conference was a review of new technology
that holds the promise of substantial mortality reduction from lung
cancer. These new technologies include low- dose spiral CT scan,
autofluorescent bronchoscopy, and molecular markers in sputum
cytology. Rigorous and rapid evaluation of these new technologies is
essential in order to ensure confidence in their efficacy and timely
application of their findings.
At this time, only one large trial with chest x-ray screening is
ongoing, although newer modalities are being investigated in other
studies around the world. The conference concluded that additional
studies are needed. It is especially important that investigation of
new early detection technologies receive high scientific and public
For those who develop lung cancer, the outcome is dramatically better
when the disease is detected at an early stage and surgically
treated. Unfortunately, at this time, the majority of lung cancers
are diagnosed when the disease is overtly symptomatic, and in an
advanced stage when prognosis is extremely poor. Available clinical
data demonstrate that the vast majority of curable lung cancers are
currently detected by chest x-rays and CT scan although there is no
proven strategy to assure early detection.
The conference encourages national governments and public health
organizations involved in cancer prevention and control to more
aggressively address tobacco control and to urgently consider the
issues surrounding the early detection of lung cancer. The conference
recognizes that current and former smokers must be advised of their
continuing risk of lung cancer. In order to address these issues,
organizations must support research on new diagnostic techniques and
chemoprevention. They must also develop recommendations regarding how
health care providers and high-risk patients can make informed
decisions about monitoring for the occurrence of lung cancer.