Personalized lung cancer screening: the value of spirometry and emphysema as risk modifiers

In 2011 the National Lung Cancer Screening Trial (NLST) showed that screening lowered lung cancer mortality from 1.66% in the computed tomography (CT) arm to 1.33% in the chest X-ray arm (1). Based on the NSLT results the US Preventive Services Task Force (USPSTF) recommended annual screening with chest CT in current smokers (or former smokers quitted less than 15 years) of 55 to 77 years with a smoking history of 30 pack years in the USA (2). Several prominent medical societies like the American Thoracic Society and American College of Chests Physicians subsequently endorsed lung cancer screening with CT. Critics have argued that the USPSTF eligibility criteria lead to a too high rate of false-positives resulting in an unfavorable risk-benefit ratio.