What are the problems in the current lung cancer screening system? Viewing from the screening-coordinator's standpoint

Because of the consolidation of smaller municipalities and revision of the Tuberculosis Prevention Law in 2005, the Japanese lung cancer screening system underwent a great change. Since the proportion of individuals receiving chest mass screening in Okayama prefecture has decreased since revision of the Tuberculosis Prevention Law, we investigated the problems in the current lung cancer screening system. As the causes of the decrease, we considered the following. First, individuals aged 64 or less were excluded from screening by the Tuberculosis Prevention Law in 2005. Second, the chest screening was included in the general screening program for the elderly population in many municipalities. Third, the cost for individuals receiving screening increased and the following diagnostic work-up costs were charged to health insurance instead of municipalities. Furthermore, the municipalities recently initiated the bid for the screening, which may have resulted in assignment of screening to the companies conducting it at low cost without sufficient consideration of accuracy. As a result screening participants may not be offered a uniformly accurate screening program. If the lung cancer screening is conducted without consideration for quality control, the usefulness of lung cancer screening will be lost. Therefore, it is necessary for municipalities to disclose information about the screening outcome, and we must reconsider the best lung cancer screening system for all municipalities and participants.