Early Detection and Screening
- The National Lung Screening Trial (NLST) randomized high-risk current and former smokers to three annual screens with either low-dose computed tomography (LDCT) or chest radiography (CXR) and demonstrated a significant reduction in lung cancer mortality in the LDCT arm after a median of 6.5 years' follow-up. We report on extended follow-up of NLST subjects.
- Lung cancer remains the leading cause of cancer-related mortality worldwide. Tobacco consumption remains the most important risk factor. Although the prevalence of smoking has decreased overall, it continues to be a significant burden for global health. It is estimated that there are still nearly 1 billion cigarette smokers worldwide. Prevention strategies have largely focused on tobacco control and prevention. However, we have witnessed a dramatic increase in the use of e-cigarettes and other vaping products.
- The present review is an update of the research and development efforts regarding the use of molecular biomarkers in the lung cancer screening setting. The two main unmet clinical needs, namely, the refinement of risk to improve the selection of individuals undergoing screening and the characterization of undetermined nodules found during the computed tomography–based screening process are the object of the biomarkers described in the present review. We first propose some principles to optimize lung cancer biomarker discovery projects.
- In lung cancer screening practice low-dose computed tomography, diameter, and volumetric measurement have been used in the management of screen-detected lung nodules. The aim of this study was to compare the performance of nodule malignancy risk prediction tools using diameter or volume and between computer-aided detection (CAD) and radiologist measurements.
- The isolation and analysis of circulating cell-free tumor DNA in plasma is a powerful tool with considerable potential to improve clinical outcomes across multiple cancer types, including NSCLC. Assays of this nature that use blood as opposed to tumor samples are frequently referred to as liquid biopsies. An increasing number of innovative platforms have been recently developed that improve not only the fidelity of the molecular analysis but also the number of tests performed on a single specimen.
- The electronic nose (e-nose) is a promising technology as a useful addition to the currently available modalities to achieve lung cancer diagnosis. The e-nose can assess the volatile organic compounds detected in the breath and derived from the cellular metabolism. Volatile organic compounds can be analyzed to identify the individual chemical elements as well as their pattern of expression to reproduce a sensorial combination similar to a fingerprint (breathprint). The e-nose can be used alone, mimicking the combinatorial selectivity of the human olfactory system, or as part of a multisensorial platform.
- Improvements in clinical management of lung cancer have been modest over the last 20 years and with almost 1.6 million deaths worldwide (19% of the total) it still has the highest mortality rate among cancers. So far no valid biomarker has proven to be useful in lung cancer clinical practice and in reducing mortality. Technical limitations, as well as genetic and biological tumor heterogeneity have likely limited the successful identification of tumor-specific markers. An interesting landmark to identify novel and more reliable biomarkers is searching for candidates by looking not only at the tumor itself but also at the interplay between the tumor and the host with the aim to identify changes related to the biological reactivity of the host to a developing cancer.