Review of the future of lung cancer screening

Lung cancer screening has progressed greatly in the last two decades since the initial publication of Early Lung Cancer Action Project (ELCAP) in 1999. Since then, large randomized trials, the National Lung Screening Trial (NLST) and NELSON studies, have also shown the benefit of lung cancer screening with CT, and it is now widely available. There are many areas for improving the benefit of screening by refining the eligibility criteria, continued optimization of the screening regimen, identifying other related diseases, and improved treatment. As artificial intelligence (AI) techniques continue to improve, an automated report of all diseases can be produced from the low-dose CT scan. New screening tests are being developed for lung cancer including blood-based tests. There is growing recognition that use of risk factor-based criteria which dichotomize age and pack-years of smoking to select eligible individuals for screening may not be the most efficient and may also lead to increased lung cancer disparity. Continued research will focus on optimal approaches for selecting high risk individuals for lung cancer screening and thus hopefully expand eligibility criteria beyond the current criteria which include only 20% of lung cancer patients. With the increase in early stage lung cancers identified from lung cancer screening, a key focus of ongoing research is the treatment of these cancers.