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Open Access Review

Lung cancer screening: from imaging to biomarker

Dong Xiang1, Bicheng Zhang2, Donald Doll1, Kui Shen3, Goetz Kloecker4* and Carl Freter1*

Author Affiliations

1 Division of Hematology and Medical Oncology, Ellis Fischel Cancer Center, University of Missouri, Columbia, MO, USA

2 Department of Oncology, Wuhan General Hospital of Guangzhou Command, People’s Liberation Army, Wuhan, Hubei, China

3 Magee-Wowens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA

4 Division of Hematology and Medical Oncology, Department of Medicine, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA

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Biomarker Research 2013, 1:4  doi:10.1186/2050-7771-1-4

Published: 16 January 2013

Abstract

Despite several decades of intensive effort to improve the imaging techniques for lung cancer diagnosis and treatment, primary lung cancer is still the number one cause of cancer death in the United States and worldwide. The major causes of this high mortality rate are distant metastasis evident at diagnosis and ineffective treatment for locally advanced disease. Indeed, approximately forty percent of newly diagnosed lung cancer patients have distant metastasis. Currently, the only potential curative therapy is surgical resection of early stage lung cancer. Therefore, early detection of lung cancer could potentially increase the chance of cure by surgery and underlines the importance of screening and detection of lung cancer. In the past fifty years, screening of lung cancer by chest X-Ray (CXR), sputum cytology, computed tomography (CT), fluorescence endoscopy and low-dose spiral CT (LDCT) has not improved survival except for the recent report in 2010 by the National Lung Screening Trial (NLST), which showed a 20 percent mortality reduction in high risk participants screened with LDCT compared to those screened with CXRs. Furthermore, serum biomarkers for detection of lung cancer using free circulating DNA and RNA, exosomal microRNA, circulating tumor cells and various lung cancer specific antigens have been studied extensively and novel screening methods are being developed with encouraging results. The history of lung cancer screening trials using CXR, sputum cytology and LDCT, as well as results of trials involving various serum biomarkers, are reviewed herein.