Five reasons for caution in advocating low-dose computerized tomographic lung cancer screening.

The 53.5K-person, low-dose computerized tomographic (LDCT), National Lung Cancer Screening Trial (NLST) achieved a 20% reduction in lung cancer mortality and a 6.7% reduction in all-cause mortality at 6.5-year median follow-up. Failure of European LDCT trials employing null (i.e., unscreened) controls to reproduce this benefit compels caution in adopting a policy of population screening. Additional concerns merit attention: surgical mortality is not trivial; overdiagnosis is substantial; disease-free life expectancy and quality of life are markedly diminished by loss of pulmonary reserve; the combination of overdiagnosis and diminished disease-free life expectancy is pernicious.