Prevention, early detection, and screening

Many options are available to help with smoking cessation. Nonetheless, the success rates of smoking cessation programs are rather low, and half of all lung cancer cases occur in those who have stopped smoking. To help to reduce the incidence of lung cancer, recent efforts have been directed to chemoprevention. Chemoprevention is defined as the use of specific agents to reverse, suppress, or prevent the process of carcinogenesis. The rationale for chemoprevention is based on two main concepts, multistep carcinogenesis and ‘field cancerization’, which can be used to explain the process of lung carcinogenesis as it occurs over time and throughout the entire bronchoalveolar epithelium. Although chemoprevention as a means of reducing cancer incidence has been successful for breast and prostate cancer, it is a developing area of research for lung cancer. The main goal for lung cancer chemoprevention is to find a compound with a favorable toxicity profile for patients who are at high risk for primary or secondary lung cancer. A number of compounds have been tested, but results of trials to date have been negative or, in the case of beta-carotene and retinoids, even detrimental. A comprehensive overview of past and ongoing chemoprevention trials can be found in the paper by Omenn.1 Based on these data, the American College of Chest Physicians (ACCP) formulated guidelines which are summarized in Table 4.1.2