Korean Journal of Health Promotion

Close Menu

Search

Close

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

Review Article

Published online: December 31, 2019

DOI: https://doi.org/10.15384/kjhp.2019.19.4.166

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

Sang Won Shin1, Jungkwon Lee2

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 September 25, 2019       Revised September 30, 2019       Accepted September 30, 2019

Copyright © 2019 Korean Society for Health Promotion and Disease Prevention

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.

Key words: Lung cancer; Screening; Korea

REFERENCES
REFERENCES
1. National Lung Screening Trial Research Team. Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365(5):395-409.
[Article] [PubMed] [PMC]
2. Aberle DR, DeMello S, Berg CD, Black WC, Brewer B, Church TR, et al. Results of the two incidence screenings in the National Lung Screening Trial. N Engl J Med 2013;369(10):920-931.
[Article] [PubMed] [PMC]
3. Robbins HA, Callister M, Sasieni P, Quaife SL, Cheung LC, Brennan P, et al. Benefits and harms in the National Lung Screening Trial: expected outcomes with a modern management protocol. Lancet Respir Med 2019;7(8):655-656.
[Article] [PubMed] [PMC]
4. Okereke IC, Nishi S, Zhou J, Goodwin JS. Trends in lung cancer screening in the United States, 2016-2017. J Thorac Dis 2019;11(3):873-881.
[Article] [PubMed] [PMC]
5. Reich JM, Kim JS. Five reasons for caution in advocating low-dose computerized tomographic lung cancer screening. J Thorac Dis 2017;9(9):3433-3436.
[Article] [PubMed] [PMC]
6. Pinsky PF. Lung cancer screening with low-dose CT: a world-wide view. Transl Lung Cancer Res 2018;7(3):234-242.
[Article] [PubMed] [PMC]
7. Bach PB, Brawley OW, Silvestri GA. Low-dose CT for lung cancer screening. Lancet Oncol 2018;19(3):e133-e134.
[Article] [PubMed]
8. O'Dowd EL, Ten Haaf K. Lung cancer screening: enhancing risk stratification and minimising harms by incorporating information from screening results. Thorax 2019;74(9):825-827.
[Article] [PubMed]
9. The Lancet Respiratory Medicine. Lung cancer screening in Europe: hurdles to overcome. Lancet Respir Med 2018;6(12):885.
[Article] [PubMed]
10. Oudkerk M, Devaraj A, Vliegenthart R, Henzler T, Prosch H, Heussel CP, et al. European position statement on lung cancer screening. Lancet Oncol 2017;18(12):e754-e766.
[Article] [PubMed]
11. Hutchinson L. Screening: NELSON shows less is more in lung cancer screening. Nat Rev Clin Oncol 2014;11(12):682.
[Article] [PubMed]
12. Horeweg N, van der Aalst CM, Vliegenthart R, Zhao Y, Xie X, Scholten ET, et al. Volumetric computed tomography screening for lung cancer: three rounds of the NELSON trial. Eur Respir J 2013;42(6):1659-1667.
[Article] [PubMed]
13. Reich JM, Kim JS. The National Lung Screening Trial premise of null and chest radiography equivalence is open to question. AJR Am J Roentgenol 2015;205(2):278-279.
[Article] [PubMed]
14. Snowsill T, Yang H, Griffin E, Long L, Varley-Campbell J, Coelho H, et al. Low-dose computed tomography for lung cancer screening in high-risk populations: a systematic review and economic evaluation. Health Technol Assess 2018;22(69):1-276.
[Article] [PubMed] [PMC]
15. Ruano-Ravina A, Pérez-Ríos M, Casàn-Clará P, Provencio-Pulla M. Low-dose CT for lung cancer screening. Lancet Oncol 2018;19:e131-e132.
[Article] [PubMed]
16. Howard DH, Richards TB, Bach PB, Kegler MC, Berg CJ. Comorbidities, smoking status, and life expectancy among individuals eligible for lung cancer screening. Cancer 2015;121(24):4341-4347.
[Article] [PubMed] [PMC]
17. Yankelevitz DF, Smith JP. Understanding the core result of the National Lung Screening Trial. N Engl J Med 2013;368(15):1460-1461.
[Article]
18. Reich JM. Reservations regarding lung cancer screening guidelines. Chest 2018;154(3):715-716.
[Article] [PubMed]
19. Patz EF Jr, Pinsky P, Gatsonis C, Sicks JD, Kramer BS, Tammemägi MC, et al. Overdiagnosis in low-dose computed tomography screening for lung cancer. JAMA Intern Med 2014;174(2):269-274.
[Article] [PubMed] [PMC]
20. Detterbeck FC. Overdiagnosis during lung cancer screening: is it an overemphasised, underappreciated, or tangential issue? Thorax 2014;69(5):407-408.
[Article] [PubMed]
21. Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA 2012;307(22):2418-2429.
[Article] [PubMed] [PMC]
22. National Lung Screening Trial Research Team. Church TR, Black WC, Aberle DR, Berg CD, Clingan KL, et al. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med 2013;368(21):1980-1991.
[Article] [PubMed] [PMC]
23. Bach PB. Perilous potential: the chance to save lives, or lose them, through low dose computed tomography screening for lung cancer. J Surg Oncol 2013;108(5):287-288.
[Article] [PubMed]
24. Twombly R. Lung cancer screening trial financed by tobacco-funded foundation, sparks debate. J Natl Cancer Inst 2008;100(10):690-691.
[Article] [PubMed]
25. Reich JM. A critical appraisal of overdiagnosis: estimates of its magnitude and implications for lung cancer screening. Thorax 2008;63(4):377-383.
[Article] [PubMed]
26. Harris RP, Sheridan SL, Lewis CL, Barclay C, Vu MB, Kistler CE, et al. The harms of screening: a proposed taxonomy and application to lung cancer screening. JAMA Intern Med 2014;174(2):281-285.
[Article] [PubMed]
27. Tanner NT, Silvestri GA. Shared decision-making and lung cancer screening: let's get the conversation started. Chest 2019;155(1):21-24.
[Article] [PubMed]
28. De Allie G, Tanksley P, Chang EY. Physicians' Responsibilities in Shared Decision-making for Lung Cancer Screening. JAMA Intern Med 2019;179(7):994-995.
[Article] [PubMed]
Table 1
Taxonomy of the harms of LDCT lung screening: domains and definitions26)
kjhp-19-166-i001

Abbreviation: LDCT, low dose computed tomography.

Table 2
Benefits and harms of LDCT lung screening1,19,26)
kjhp-19-166-i002

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

Copyright © Korean Society For Health Promotion And Disease Prevention.
View Full Site

Go to Top