May 1st 2004
At this time, two positions aboutlung cancer screening are defensiblebased on current evidence.First, it is quite reasonable todefend the position that there is insufficientevidence to recommend population-based screening for lung cancerwith spiral computed tomography(CT) for individuals at increased riskfor lung cancer. Despite very favorableresults from observationalstudies,[2-4] broad consensus aboutpolicy depends, at a minimum, on resultsfrom a prospective randomizedtrial comparing lung cancer mortalityin an experimental group with a controlgroup. Ideally, this comparison isbetween a group invited to screeningand a group receiving usual care, andsuch trials have begun in France, theNetherlands, and Italy, but decisionsalso may be made for alternative comparisonsif circumstances warrant adifferent randomization scheme. TheNational Lung Screening Trial has justcompleted recruiting 50,000 individualsat elevated risk to a prospectiverandomized trial comparing chest radiographyto spiral CT.