Optimizing lung cancer screening: nodule size, volume doubling time, morphology and evaluation of other diseases

Of all cancers, lung cancer causes the most deaths in the United States (US) (1). In fact, lung cancer causes more deaths than colon-, breast- and pancreatic cancer together. One of the reasons for this high mortality rate is that lung cancer often remains undetected until in a relatively advanced stage. At advanced stages curative treatment has low success rates or is not even an option. Given that lung cancer in the vast majority of cases is caused by tobacco smoking, subjects with high smoking exposure are at a higher risk of developing lung cancer. This leads to the rationale of lung cancer screening in heavily exposed current and former smokers. Already in 2011 the largest lung cancer screening trial with low-dose computed tomography (CT), the National Lung Screening Trial (NLST), showed a >20% reduction in lung cancer mortality as well as a 7% reduction in total mortality in high-risk subjects screened with CT, compared to those screened with chest radiographs (2).