Screening and diagnosis of NSCLC.

Lung cancer is the biggest cancer killer in Europe. Non-smallcell lung cancer (NSCLC) accounts for the vast majority of cases. The annual number of newly diagnosed patients in Europe exceeds 200 000, accounting for 20% of all cancer deaths, and on average 28% of male cancer deaths across the continent [1, 2]. In females, lung cancer accounts for 10% of deaths. Five-year survival is 9.6%, ranging from 5.9% in Denmark to 16.2% in Switzerland [3]. Despite these figures and the fact that screening is an accepted strategy in invasive cancers with similar incidence but lesser mortality and better survival than lung cancer, e.g. breast, colorectal and prostate cancer, screening in lung cancer is not routinely advocated. The introduction of low-dose spiral computed tomography (LD-SCT) has reopened the debate. The present status of lung cancer screening will be reviewed here. For cancer registration and treatment reasons, a lung cancer diagnosis should be confirmed whenever possible. The various methods of obtaining a tissue diagnosis and their accuracy will be reviewed.