Early detection in lung cancer: Case finding and screening

Lung cancer, a common and deadly disease, is a tempting target for programs of intervention based on early detection. These programs have been hampered by the biologic variability of the disease and by imperfect detection tools (chest radiography and sputum cytology). Multiple large clinical studies over the past 40 years have failed to demonstrate a favorable impact of screening on the mortality rate from lung cancer. Medical decision making in this area must be baked on an understanding of the pros and cons of early detection and an appreciation of the difference between screening and individualized case finding.