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National Lung Cancer Screening Program in Korea: More Harm Than Good

Article information

Korean J Health Promot. 2019;19(4):166-170
Publication date (electronic) : 2019 December 31
doi : https://doi.org/10.15384/kjhp.2019.19.4.166
Sang Won Shin1orcid_icon, Jungkwon Lee2orcid_icon
1Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
2Department of Family Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
Corresponding author: Sang Won Shin, MD, PhD. Department of Internal Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea. Tel: +82-2-920-5350, Fax: +82-2-920-5680, shinsw9295@gmail.com
Received 2019 September 25; Revised 2019 September 30; Accepted 2019 September 30.

Abstract

Although the result of low dose computed tomography (LDCT) screening for high risk smoker for lung cancer (National Lung Screening Trial, NLST) showed 20% of lower lung cancer death compare to chest X-ray screening, which published in 2011, after more than 8 years passed, no European or Asian country has implemented organized lung cancer screening with LDCT, and there are no National Lung Cancer Screening Program globally. In United States, where LDCT lung screening has become standard procedure, the screening rate is extremely low, less than 5%. That is because in spite of the considerable the benefit of the screening, the harms of screening; specifically, most notably due to the high level of false positives, and physical, psychological, and economical burdens. Recently the controversies regarding the harms of LDCT lung screening has been increasingly debated. Also, the novel strategies, such as artificial intelligence and volumetric measurement of suspicious nodules has been adopted for recently launched lung cancer screening clinical trials. However, amid of skeptical opinions increasing globally, Korean Government recently decided to include LDCT lung cancer screening as national cancer screening program, becoming Korea as the first and the only national lung cancer screening program worldwide. Without randomized trial proven to be effective for Korea population, hurried implementation of national lung cancer screening program could have more harmful effect than benefit in terms of public health perspectives.

Keywords: Lung cancer; Screening; Korea

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Copyright © 2019 Korean Society for Health Promotion and Disease Prevention
Korean Society for Health Promotion and Disease Prevention

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Table 1

Taxonomy of the harms of LDCT lung screening: domains and definitions26)

Table 1

Abbreviation: LDCT, low dose computed tomography.

Table 2

Benefits and harms of LDCT lung screening11926)

Table 2

Abbreviations: CT, computed tomography; LDCT, low dose computed tomography.