Lung cancer screening

Lung cancer (LC) is the most common and fatal cancer worldwide; in the USA it remains the deadliest cancer despite decreasing incidence. Emergency physicians currently encounter LC in various ways. Patients go to the emergency department (ED) for disease or treatment complications. Others are diagnosed with LC in the ED, likely already advanced and refractory to treatment. Lastly, incidental lesions that are likely benign but have a small chance of representing early cancer are encountered and evaluated. Localized LC has a 5-year survival rate of 59% and advanced LC just 5.8%. Only 17% present early, highlighting the need for detection before symptoms develop. Lung cancer screening (LCS) of high-risk asymptomatic individuals with low-dose computed tomography (LDCT) was shown in 2011 to reduce mortality by finding LC at earlier stages. Critics cited high false positive rates leading to unnecessary distress, radiation, and procedures, but progress in decreasing unintentional harm has been made. Currently only a fraction of eligible patients are screened even though the Centers for Medicare and Medicaid Services (CMS) approved LDCT screening for LC as a preventative health service at 100% coverage in 2015. Many patients at high risk for LC are likely coming to the ED for other reasons. We will review current evidence regarding LCS benefits and harms, barriers to screening, and how the new field of oncologic emergency medicine may help close current LCS gaps.