This week, the American Academy of Family Physicians (AAFP) elected to not follow the lead of the more influential US Preventive Services Task Force (USPSTF), which previously reviewed the information on chest CT screening for high risk patients and recommended it, and

One of the principles of screening is that the likelihood of detecting a cancer depends greatly on the risk that a person being screen has for developing that cancer. Low risk means that it is very likely that any abnormality that is detected is more likely to be unrelated to cancer. And because of that, nearly all of the screening efforts thus far have focused on patients with a significant smoking history.

Some members had previously asked about a breath test to detect lung cancer, and at the time I was not familiar with this work.

Thanks to member Carlos for bringing to our attention a high profile article in the New York Times today about some controversy now surrounding the Early Lung Cancer Action Project (ELCAP) trial, probably the most influential study of CT screening that has been done. Let me disclose immediately that my own institution, Swedish Hospital in Seattle, is a participating site in ongoing CT screening work led by Dr.

An interesting article just came out in the Journal of Clinical Oncology from researchers at Duke, led by Dr. Ed Patz of the Radiology Department there (abstract here).

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.