J Korean Med Assoc.  2015 Apr;58(4):291-301. 10.5124/jkma.2015.58.4.291.

The Korean guideline for lung cancer screening

• Jang SH
• Sheen S
• Kim HY
• Yim HW
• Park BY
• Kim JW
• Park IK
• Kim YW
• Lee KY
• Lee KS
• Lee JM
• Hwangbo B
• Paik SH
• Kim JH
• Sung NJ
• Lee SH
• Hwang SS
• Kim SY
• Kim Y
• Lee WC
• Sung SW

• KMID: 2194961
• DOI: http://doi.org/10.5124/jkma.2015.58.4.291

Abstract

Lung cancer is the leading cause of cancer death in many countries, including Korea. The majority of patients are inoperable at the time of diagnosis because symptoms are typically manifested at an advanced stage. A recent large clinical trial demonstrated significant reduction in lung cancer mortality by using low dose computed tomography (LDCT) screening. A Korean multisociety collaborative committee systematically reviewed the evidences regarding the benefits and harms of lung cancer screening, and developed an evidence-based clinical guideline. There is high-level evidence that annual screening with LDCT can reduce lung cancer mortality and all-cause mortality of high-risk individuals. The benefits of LDCT screening are modestly higher than the harms. Annual LDCT screening should be recommended to current smokers and ex-smokers (if less than 15 years have elapsed after smoking cessation) who are aged 55 to 74 years with 30 pack-years or more of smoking-history. LDCT can discover non-calcified lung nodules in 20 to 53% of the screened population, depending on the nodule positivity criteria. Individuals may undergo regular LDCT follow-up or invasive diagnostic procedures that lead to complications. Radiation-associated malignancies associated with repetitive LDCT, as well as overdiagnosis, should be considered the harms of screening. LDCT should be performed in qualified hospitals and interpreted by expert radiologists. Education and actions to stop smoking must be offered to current smokers. Chest radiograph, sputum cytology at regular intervals, and serum tumor markers should not be used as screening methods. These guidelines may be amended based on several large ongoing clinical trial results.

Keyword

Early detection of cancer; Lung neoplasms; Clinical practice guidelines; Low dose chest computed tomography

MeSH Terms

Biomarkers, Tumor
Diagnosis
Early Detection of Cancer
Education
Follow-Up Studies
Humans
Korea
Lung
Lung Neoplasms*
Mass Screening*
Mortality
Radiography, Thoracic
Smoke
Smoking
Sputum
Smoke

Figure

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  Figure 1 Analysis framework of lung cancer screening guidelines. ① Benefits of screening, ② harms of screening, ③ primary population of and screening, ④ frequency and period of screening, ⑤ other screening methods, ⑥ quality control of screening. CT, computed tomography.

• 

  Figure 2 Flowchart of lung cancer screening guideline selection.

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  Figure 3 Effects of low dose computed tomography (LDCT) screening on (A) death from lung cancer and (B) all cause mortality. IV, inverse variance; CI, confidence interval; NLST, National Lung Screening Trial; DANTE, Detection and Screening of Early Lung Cancer by Novel Imaging Technology and Molecular Essays; DLCST, Danish Lung Cancer Screening Trial.

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