Do I have a small cell or non-small cell lung cancer?
How far has the lung cancer spread? What stage is my cancer?
What are my chances for recovery?
Can you surgically remove my lung cancer?
How will the surgery affect my breathing or quality of life?
Will I need chemotherapy or radiotherapy?
What are the goals of these lung cancer treatments?
Philadelphia Pulmonary Neoplasm Research Project, a nonrandomized, uncontrolled study that began in 1951.
Veterans Administration study, a nonrandomized, uncontrolled study that was conducted from 1958 to 1961.
South London Lung Cancer Study, a nonrandomized, uncontrolled study that was conducted from 1955 to 1963.
North London Cancer Study,[4,5] a randomized study that was conducted in the early 1960s and randomly assigned industrial firms to screening and no screening groups.
Kaiser Foundation Health Plan multiphasic screening trial,[6,7] a controlled trial that began in 1964 and included annual chest x-ray, spirometry, and medical questionnaire as part of the multiphasic screening.
None of these studies reported a statistically significant benefit of screening on lung cancer mortality. As an example, the South London study reported an increase in survival from the time of diagnosis of screen-detected lung cancer cases compared with other cases found in the same geographical region. There was, however, no adjustment for self-selection bias, lead-time bias, overdiagnosis bias, or length bias. Additionally, these studies were small, with a short follow-up period of typically less than 10 years, so that a small-to-moderate size or long-term effect was not demonstrable.
Other lung cancer screening investigations include a randomized trial in Czechoslovakia, a nonrandomized but controlled trial in the former German Democratic Republic (GDR), and case-control studies in the former GDR  and Japan.[11,12] The participants in the randomized arms of the Czechoslovakian study were screened with x-ray and cytology at two different frequencies, semiannual versus every 3 years. There was no unscreened control group. No difference in lung cancer mortality was observed; the relative risk (RR, screen group/control group) was 1.36 (95% confidence interval [CI], 0.94-1.98). The GDR nonrandomized study used semiannual chest fluoroscopy over a 6-year period in the intervention arm, while control patients were scheduled to undergo the same exam at 1-year to 2-year intervals. Allocation was based on district of residence. No reduction was observed in lung cancer mortality; the RR was 1.34 (95% CI, 0.94-1.98). Chest x-rays originally used for control of tuberculosis were evaluated in the German case-control study. The odds ratio (OR) showed no association between lung cancer death and having received a screening chest x-ray in both a general population-based control group (OR = 0.9; 95% CI, 0.5-1.5) and a hospital-based control group (OR = 1.1; 95% CI, 0.7-1.8). X-ray histories among deceased lung cancer cases and matched controls were considered in a Japanese case-control study. In contrast to the German study, there was a suggestion of some screening benefit; the OR of dying from lung cancer for those screened within 12 months versus those not screened was 0.72 (95% CI, 0.50-1.03). A meta-analysis of four other case-control studies conducted in Japan suggested mortality reductions of approximately 40%, but potential for bias in these studies has been noted.