Sensitivity and specificity of chest X-ray screening for lung cancer - Review article

BACKGROUND. The incidence and mortality rates of lung carcinoma have been i ncreasing during the last years. Despite this, medical public policy holds that chest X-ray screening is ineffective in the early detection of lung ca rcinoma. METHODS. The authors reviewed the most important studies published in the l iterature regarding the role of chest X-ray screening in the early diagnosi s of lung carcinoma in a high risk population. None of the four randomized, controlled trials on lung carcinoma screening conducted in male cigarette smokers demonstrated a reduction in the mortality rate. Accordingly, no org anization that formulates screening policy advocates any specific early det ection strategies for lung carcinoma. RESULTS. A careful analysis of randomized, controlled trials showed that th ere was no improvement in the mortality rate in the screened populations, b ut there is considerable evidence that chest X-ray screening is associated with earlier detection and improved survival. CONCLUSIONS. In the authors' opinion, the considerable improvements in dist ribution by disease stage, tumor resectability, and patient survival in the screened groups demonstrate the effectiveness of chest X-ray screening in the early detection of lung carcinoma. The authors conclude that radiograph ic screening is the only valid method of secondary prevention in cigarette smokers; Cancer 2000;89: 2453-6. (C) 2000 American Cancer Society.