Introduction

Lung cancer remains the leading cause of mortality from cancer. In 1999, there were approximately 170,000 new cases of lung cancer [1]. The 5-year survival rate from the disease is 14% and has increased only slightly since the early 1970s despite an extensive and costly research effort to find effective therapy. The disparity in survival between early- and late-stage lung cancer is substantial, with a 5-year survival rate of approximately 70% in stage 1A disease compared to less than 5% in stage IV disease according to the recently revised Lung Cancer Staging criteria [2]. Unfortunately, as many as 60% of patients present with advanced-stage lung cancer.

The disproportionately high prevalence and mortality of advanced lung cancer has encouraged attempts to detect early lung cancer with screening programs aimed at smokers. Smokers have an incidence rate of lung cancer that is 10 times that of nonsmokers and account for greater than 80% of lung cancer cases in the United States [3]. Until recently, two main approaches have been used to screen for lung cancer: chest radiography and sputum cytol ogy. The first section of this chapter describes the evolution and results of screening studies using these techniques and the controversies that developed surrounding the results of these studies. The following section describes several emerging technologies for early lung cancer detection, with a special emphasis on low-dose spiral computed tomography (CT).

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