Considerations in developing successful, population-based molecular screening and prevention of lung cancer

The current mortality rate for lung cancer exceeds 85%, as it has for the l ast 3 decades. This statistic reflects the utility of the major diagnostic tool that has been used during this period to diagnose lung cancer: the che st X-ray. The overwhelming majority of new cases of lung cancer that are de tected with chest X-rays involve individuals who already have regional or d istant metastatic disease. Because the systemic treatment of this disease h as not improved greatly, patients with metastatic disease rarely are cured. This article reviews the issues involved with the development of sputum-ba sed cellular diagnostics for early stage lung cancer. The biomarker, hetero geneous nuclear ribonucleoprotein A2/B1, is the lead marker for this approa ch. It has been used in several studies in independent cohorts that have su ggested that its overexpression in bronchial epithelial cells is associated highly with the development of lung cancer. This marker is detectable 1 ye ar or more prior to the detection of lung cancer by chest X-ray. Finding th is early airway-confined phase of lung cancer may allow for the evolution o f new management approaches for very early stage lung cancer. Research acti vities, such aerosolized chemoprevention, are discussed. Cancer 2000;89:246 5-7. (C) 2000 American Cancer Society.