Whom to screen? A view on lung cancer screening from the pneumologist’s perspective

Worldwide, lung cancer is the leading cause of cancer-related mortality and one of the ten most frequent causes of death [ 1 , 2 ]. As with most solid malignancies, prognosis at early stages is more favourable. Unfortunately, at the time of diagnosis most patients are in an advanced stage of disease and despite recent therapeutic progress prognosis remains poor [ 3 ]. Therefore, emphasis should be set on the identification of lung cancer at an early disease stage. Due to an often asymptomatic course at early stages, screening of high-risk patients seems to be the only appropriate option to reach this goal. Thus, the aim of screening programs is the detection of clinically unapparent cancer to offer the possibility of curative treatment. So far, screening programs have been successfully established in different malignant diseases including breast, prostate, cervix or colorectal cancer. In contrast to these programs, age as the main inclusion criterion appears to be of minor relevance for lung cancer risk. Since potential benefits of disease screening are highly dependent on proper risk stratification, smoking history as most important risk factor must be included.