The National Lung Screening Trial (NLST), a protocol with over 50,000 former or current smokers between ages 55 and 75, justifiably became a major news story when the results demonstrated a significant improvement in lung cancer-specific and all-cause mortality of 20% and 6.7%, respectively.

The much-anticipated manuscript from the NCI-sponsored National Lung Screening Trial (NLST) was just published on line in the New England Journal of Medicine, with an editorial by Dr. Harold Sox.

For years and years, lung cancer advocates have often aggressively championed screening for lung cancer, while many in the medical "establishment" and policy-makers expressed reservations that, while there were encouraging indicators of benefit, there was not evidence that lung cancer screening saves lives, so we really couldn't make a blanket statement encouraging lung cancer screening.

A radiologist, the person who specializes in reviewing imaging studies in medicine, is often someone you notice if they're unusually bad or unusually good. They perform a service and you presume that they're good at it, but a few are so sharp that the other doctors they work with notice it at every tumor board discussion or one on one exchange.

On March 24, 2009, Dr. West wrote,

Lung cancer screening is one of my least favorite topics to discuss because it's probably one of the biggest areas where there is a gulf between the medical establishment's party line and the expectations of many patients and advocates. I tackled a discussion of screening a few years ago that included the anticipated benefits as well as the challenges with LC screening (nowadays really focusing on low dose, spiral CT).

Well, as I suspected, the topic of lung cancer cancer screening has been a bit of a minefield, but I'm going to end now by trying to pull together where we are here and now, at least in the US.

The topic of lung cancer screening is a very charged one, with most people, patients and physicians alike, having a strong opinion, either for or against. This is also an area in which there can be suspicion that any argument against screening is due to a financial calculation in which saving people from lung cancer isn't worth the cost of imaging. Any screening discussion also entails a consideration of cost, financial and other, vs. benefit, but here I'll focus on the issues related to the possible shortcomings of lung cancer screening in terms other than cost.

The issue of CT screening for lung cancer is a big one, and to handle it properly I'm going to write about it in a few installments. It's also quite controversial, so today I'll start with the reasons in favor of CT screening. Just by means of background, I'll start by saying that chest x-rays have been studied for screening, but they don't provide enough detail, requiring tumors to be larger before they are reliably detectable, and location of the tumor can be a problem.