Lung cancer screening-don’t forget the chest radiograph

Abstract

Lung cancer is a major health burden and early detection only bears the possibility of curative treatment. Screening with computed tomography (CT) recently demonstrated a mortality reduction in selected patients and has been incorporated in clinical guidelines. Problems of screening with CT are the excessive number of false positive findings, costs, radiation burden and from a global point of view shortage of CT capacity. In contrast, chest radiography could be an ideal screening tool in the early detection of lung cancer. It is widely available, easy to perform, cheap, the radiation burden is negligible and there is only a low rate of false positive findings. Large randomized controlled trials could not show a mortality reduction, but different large population-based cohort studies have shown a lung cancer mortality reduction. It has been argued that community-based cohort studies are more closely reflecting the “real world” of everyday medicine. Radiologists should be aware of the found mortality reduction and realize that early detection of lung cancer is possible when reading their daily chest radiographs. Offering a chest radiograph in selected scenarios for the early detection of lung cancer is therefore still justified.

Keywords: Lung cancer; Screening; Mortality; Chest radiograph

Core tip: Screening with computed tomography (CT) recently demonstrated a mortality reduction in selected patients with lung cancer, but there are several shortcomings of screening with CT (false positive findings, high costs, radiation burden, shortage of capacity). In contrast, chest radiography could be an ideal screening tool in the early detection of lung cancer. It is widely available, its radiation burden is negligible and there is only a low rate of false positive findings. In contrast to randomized controlled trials different large population- based cohort studies have shown a lung cancer mortality reduction using chest radiography. In conclusion, early detection of lung cancer is also possible with chest radiography.