Screening for lung cancer revisited and the role of sputum cytology and fluorescence bronchoscopy in a high-risk group

Lung cancer is an epidemic disease that is underrepresented in the research funding for early detection and chemoprevention arenas. Screening programs have been discouraged for both financial and political reasons. Yet, incre asing evidence suggests that screening and early detection may improve outc ome in lung cancer. Sputum cytology examination has been shown in several s tudies to lead to detection of lung cancer at an earlier stage, resulting i n an improved 5-year survival rate. Monoclonal antibody detection, fluoresc ence bronchoscopy, and low-dose spiral CT increase diagnostic sensitivity a nd improve the ability to localize early-stage lesions. Utilizing these new techniques and improving the definition of high-risk groups may improve th e success and cost-effectiveness of early detection based on sputum cytolog y, The ultimate goal of improving longterm survival in lung cancer will be achieved only when cancer can be detected in its early stages and lesions c an be localized in large numbers. Advances in the last 15 years offer an en couraging vision for the value of early detection and effective treatment f or lung cancer.