New concepts in lung cancer screening.

Although spiral CT has an undeniably impressive ability to detect occult lung cancers in asymptomatic smokers, it is not clear whether screening this patient group will lead to a reduction in disease-specific mortality. The specter of overdiagnosis in lung cancer screening, which manifested during the chest radiograph trials of the 1970s and 1980s, still hangs over screening regimes today. The detection of premalignant lesions by molecular medicine techniques and fluorescence bronchoscopy may allow the development of novel treatments for preinvasive disease, but it is likely that radiologic means of detection will form the front line of any near future screening program. The proposed screening techniques may be new, but their use must be tested against tried and trusted standards of medical practice.