The NLST screening study has demonstrated a decrease in mortality from lung cancer in patients undergoing low-dose CT assessment. The resources required to roll out a CT screening programme are huge. The medical community is currently awaiting to see if the NLST trial results are confirmed by one or more of the other ongoing studies in Europe. None of these are individually as large as the NLST study, but in combination they might provide sufficient evidence to recommend screening across the general smoking population. What is not yet defined is how wide the screening net should be cast, whether the parameters used by the NLST are appropriate, and which nodules require further follow-up and further investigation. Currently, both in Europe and the United States, it is agreed that the patients undergoing screening CT should do so according to agreed guidelines. These guidelines also advise in detail about the management of screening results. The American Lung Association has also recently issued guidance on lung cancer screening to patients and physicians. In the UK a recent opinion piece from the UK Lung Screening (UKLS) group neatly defines the problems that remain unresolved as psychosocial and cost-effectiveness issues, harmonisation of CT acquisition techniques, management of findings, screening frequency and subject selection.
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