Screening for Lung Cancer Has Limited Effectiveness Globally and Distracts From Much Needed Efforts to Reduce the Critical Worldwide Prevalence of Smoking and Related Morbidity and Mortality

Lung cancer is the leading cause of cancer-related mortality worldwide in both men and women. Efforts to reduce lung cancer mortality using chest x-rays (CXRs) for early detection did not show improvements in mortality. More recently, results of the National Lung Screening Trial (NLST), which used low-dose computed tomography (LDCT) scans, appear to improve mortality outcomes. However, LDCT imaging comes at prohibitive costs because of the high number needed to screen as well as inadequate biopsy yields from screen-positive cases. Thus, it is imperative that attempts be made to either improve the efficiency of lung cancer screening or reduce the prevalence of smoking. The latter is especially important considering population increases and the consequently higher prevalence of active smokers. The 2015 WHO report on the global tobacco epidemic highlights that tobacco-related deaths continue to claim more lives than AIDS, malaria, and tuberculosis combined. Hence, continued attempts to reduce the prevalence of smoking are more likely to produce greater mortality reductions than lung cancer screening strategies. Primary preventive strategies have proven benefits but remain underused.

We describe the effectiveness of strategies for smoking control and tobacco-related diseases. We also explain why it is more relevant to increase implementation of these methods than the promotion of screening techniques for lung cancer, especially in low- and middle-income countries.