Caution over use of lung-cancer screening as standard practice

Fast-growing squamous cell lung cancer

We here report a case of squamous cell carcinoma of the lung, with an unusually fast tumor growth rate, so fast that its early detection was impossible even with two sequential chest roentgenograms taken only 36 days apart. Literature related to the concept of cell growth kinetics was reviewed, and the tumor volume doubling time that characterizes any measurable tumor was calculated for our case accordingly, based on the single lesion found on the plain chest film, with the best possible estimation of its volume. We concluded that, to the best of our knowledge, a squamous cell carcinoma of the lung that grew so fast (with a tumor doubling time less than 7.5 days) has not yet been reported to date; neither has a bronchogenic carcinoma of any cell type been reported with such a presentation. Given that a patient aged 81 belonged to a group usually with slower growth in tumor cell kinetics, the behavior of his tumor was indeed uncommon.

Computed tomography screening for lung cancer: back to basics

After some years in the doldrums, interest in screening for lung cancer is resurging. Conflicting evidence from previous lung cancer screening trials, based on plain chest radiography, has been the subject of much debate: the failure to demonstrate a reduction in mortality has led to the widely held conclusion that screening for lung cancer is ineffective. The validity of this assumption has been questioned sporadically and a large study currently under way in the U.S.A. should help settle the issue. Recently, there has been interest in the use of computed tomography to screen for lung cancer; radiation doses have been reduced to 'acceptable' levels and the superiority of computed tomography (CT) over chest radiography for the identification of pulmonary nodules is unquestioned. However, whether improved nodule detection will result in a reduction in mortality has not yet been demonstrated. The present review provides a historical background to the current interest in low-dose CT screening, explains the arguments that previous studies have provoked, and discusses the recent and evolving status of lung cancer screening with CT. Ellis, S. M. et al. (2001).