Lung cancer. Screening, counseling, and treating long-term smokers.

Survival of patients with lung cancer is approximately 12%, largely because the disease is not detected until it has reached an advanced stage. Past screening trials using chest X-ray and sputum cytology were unable to demonstrate a decrease in lung cancer mortality in the screened population. Recent reports document the ability of low-dose spiral CT scans to detect lung cancer at an earlier stage (nodules as small as 5 mm versus 10 mm for chest X-ray). These initial results suggest that CT screening may improve survival and decrease mortality. Therefore, physicians should consider discussing lung cancer screening using spiral CT scans with selected high-risk individuals (60 years and older with at least 10 pack-years of cigarette smoking and no other malignancies). At the very least, all patients who smoke should be counseled to quit and offered proven pharmacotherapies.