Reflections on screening tests for lung cancer

Screening for lung cancer is a controversial issue. Much needs to be done in the area of primary prevention of lung cancer. Predictions of lung cancer mortality in Europe indicate further increases in the coming 20 years, due to the extensive number of individuals having long periods of exposure to carcinogens. The treatment of lung cancer is not solved, either, and the global epidemiological situation of lung cancer raises great concerns. Due to these reasons, it seems to be necessary to revise the issue of lung cancer screening. In Hungary, annual minimal mass roentgen screening has been done for decades. The data of more than 4.3 million individuals were analysed in 1996. Out of the symptomless patients detected, 21.4% fell into oncological stage 1, 33.7% into stage 2 and 29% into stage 3. Those patients who were not screened, but who presented with symptoms and were detected as such, can be classified into stages as follows: Stage 1: 8.7%, stage 2: 21.5% and stage 3: 36.3%. The resection rate in the screened group versus non-screened group was 34.3% and 13.7% respectively. Minimal mass roentgen screening allows the detection of lung cancer patients in an earlier stage; with improved treatment possibilities, survival rates and patients' quality of life will shift to a positive direction. It is suggested that the effectiveness of minimal mass roentgen screening of lung cancer should be revised.