Sixty Years of Lung Cancer Screening: From Sputum Cytology to Low-Dose CT and the Emerging Precision Era.
Authors
Affiliations (3)
Affiliations (3)
- University of New Mexico School of Medicine, Albuquerque, New Mexico, (A.S.R., S.L.F.). Electronic address: [email protected].
- University of New Mexico School of Medicine, Albuquerque, New Mexico, (A.S.R., S.L.F.). Electronic address: [email protected].
- Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom (A.H.S.); MSc Programme in Health Policy, Planning and Financing, London School of Economics and Political Science and London School of Hygiene & Tropical Medicine, London, United Kingdom (A.H.S.); The George Institute for Global Health, WHO Collaborating Centre for Emergency, Critical and Operative Care, London, United Kingdom (A.H.S.); NHS Cancer Programme, NHS England, London, United Kingdom (A.H.S.); Cancer Team, Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland (A.H.S.). Electronic address: [email protected].
Abstract
To trace the evolution of lung cancer screening from early radiographic and sputum cytology trials through the landmark randomized trials that established low-dose computed tomography (LDCT) as a guideline-endorsed intervention, and to examine emerging technologies poised to transform the field. A narrative synthesis of primary trial literature, guideline documents, and emerging research conducted March-May 2026. Key milestones-the Mayo Lung Project, Johns Hopkins Lung Project, Anti-Lung Cancer Association (ALCA) CT trials, Early Lung Cancer Action Project (ELCAP), National Lung Screening Trial (NLST), NELSON trial, and iterative US Preventive Services Task Force (USPSTF) guideline revisions-are reviewed chronologically alongside developments in CT technology and reporting systems. Early sputum cytology and radiographic trials improved early-stage detection without a mortality benefit. Japanese ALCA trials established LDCT feasibility, demonstrating superior stage distribution (93% vs 53% stage I). The NLST demonstrated a 20% reduction in lung cancer mortality and 6.7% reduction in all-cause mortality with LDCT versus chest radiography, providing the evidence basis for the 2013 USPSTF guidelines. NELSON corroborated these findings, with a 24% lung cancer mortality reduction in men and greater benefit in women. The 2021 USPSTF revision broadened eligibility to ages 50-80 with ≥20 pack-years. Adherence remains suboptimal at 22-55%. LDCT screening represents a convergence of technological innovation, rigorous clinical investigation, and evolving health policy. Emerging adjuncts, including circulating tumor DNA analysis and AI-assisted image interpretation, may improve detection accuracy and address adherence gaps. Lung-RADS has substantially reduced false-positive rates and continues to evolve.