Lung cancer screening with low-dose computed tomography can reduce death from lung cancer by 20–24% in high-risk smokers. National lung cancer screening programmes have been implemented in the USA and Korea and are being implemented in Europe, Canada and other countries. Lung cancer screening is a process, not a test. It requires an organised programmatic approach to replicate the lung cancer mortality reduction and safety of pivotal clinical trials. Cost-effectiveness of a screening programme is strongly influenced by screening sensitivity and specificity, age to stop screening, integration of smoking cessation intervention for current smokers, screening uptake, nodule management and treatment costs. Appropriate management of screen-detected lung nodules has significant implications for healthcare resource utilisation and minimising harm from radiation exposure related to imaging studies, invasive procedures and clinically significant distress. This review focuses on selected contemporary issues in the path to implement a cost-effective lung cancer screening at the population level. The future impact of emerging technologies such as deep learning and biomarkers are also discussed.

使用低剂量计算机断层扫描进行肺癌筛查可以将高危吸烟者的肺癌死亡率降低 20-24%。国家肺癌筛查计划已在美国和韩国实施，并正在欧洲、加拿大和其他国家实施。肺癌筛查是一个过程，而不是测试。它需要一种有组织的程序化方法来复制关键临床试验的肺癌死亡率降低和安全性。筛查计划的成本效益受筛查敏感性和特异性、停止筛查年龄、对当前吸烟者的戒烟干预整合、筛查采用、结节管理和治疗成本的强烈影响。对筛查检测到的肺结节进行适当管理对医疗保健资源的利用和最大限度地减少与影像学研究、侵入性手术和临床显着痛苦相关的辐射暴露的危害具有重要意义。本综述侧重于在人口水平上实施具有成本效益的肺癌筛查的路径中选定的当代问题。还讨论了深度学习和生物标志物等新兴技术的未来影响。