Status of lung cancer screening

CT screening emerged as an approach to improve the curability of asymptomatic lung cancer as reported in a landmark study by Henschke and her multi-disciplinary colleagues in 1999 (1). Now eighteen years later, we have a follow-up report from this group on the status of low dose CT screening particularly focusing on the screening management process in optimally delivering this service. In the years since their initial screening report, this group has developed a unique confederated structure called the International-Early Lung Cancer Action Project (I-ELCAP) to advance research while delivering best-practice with the screening process (2). This approach was adopted so that collaborating screening researchers could pool resources from their respective institutions to more rapidly complete research around the many aspects of lung cancer screening. This approach is a pragmatic accommodation to the nature of lung cancer screening, even in a defined high risk for lung cancer cohort, which will involve finding lung cancer cases typically with a frequency of about 1% on baseline. To have sufficient numbers of informative cases to conduct significant research in a timely fashion requires a vast screening populations and so cooperative interactions of many institutions pooling accrual cases is one way to address this challenge. The consortium of institutions comprising the I-ELCAP has now published a large range of studies on aspects of lung cancer screening management. A recent review was a status report of I-ELCAP current activities and it is a distillation of their body of work, organized by a series of questions that span the topic of screening, beginning with who should be screened (3).