Computed tomography screening for lung cancer: Back to basics

After some years in the doldrums, interest in screening for lung cancer is resurging. Conflicting evidence from previous lung cancer screening trials, based on plain chest radiography, has been the subject of much debate: the failure to demonstrate a reduction in mortality has led to the widely held conclusion that screening for lung cancer is ineffective. The validity of this assumption has been questioned sporadically and a large study currentl y under way in the U.S.A. should help settle the issue. Recently, there has been interest in the use of computed tomography to screen for lung cancer; radiation doses have been reduced to 'acceptable' levels and the superiori ty of computed tomography (CT) over chest radiography for the identificatio n of pulmonary nodules is unquestioned. However, whether improved nodule de tection will result in a reduction in mortality has not yet been demonstrat ed. The present review provides a historical background to the current inte rest in low-dose CT screening, explains the arguments that previous studies have provoked, and discusses the recent and evolving status of lung cancer screening with CT. (C) 2001 The Royal College of Radiologists.