Chest surgery clinics of North America
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Chest Surg. Clin. N. Am. · Nov 2000
Review Comparative StudyPrevention of lung cancer. The new millennium.
Lung cancer is the leading cause of cancer-related death worldwide and in the United States surpassing breast, prostate, and colon cancer. Treatment of this disease over the past 2 decades has advanced incrementally as survival rates have improved only slightly. ⋯ Chemoprevention has introduced a new arena of treatment options for early intervention in lung carcinogenesis. The use of molecularly targeted therapeutic and biologic agents constitutes novel strategies for lung cancer prevention in the new millennium.
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The large clinical studies of lung cancer screening carried out more than 20 years ago were interpreted as evidence against screening. Those studies have been recently reassessed in the light of methodologic flaws in the randomization of subjects at risk for lung cancer. There is no evidence to support the former conclusion that screening is ineffective and the consequent official recommendation not to screen for lung cancer. ⋯ Low-dose helical CT scan is currently believed to represent a very useful technique for screening for lung cancer, with a higher sensitivity than chest radiograph screening. Chest radiography for lung cancer screening, however, is cheaper and ubiquitously available, and it should still be recommended if CT scan is locally unavailable. As underscored in a recent commentary in The Lancet, the existing public health policy discouraging the screening for lung cancer is in urgent need of reconsideration.