Do We Need a New Model for Lung Cancer Screening?

In the lung cancer community, the percentage of patients who are diagnosed with lung cancer, but have never smoked has been growing since the early 2000s. According to surgeon Andrew Kaufman of Mount Sinai Hospital in New York, “It is well-documented that approximately 20% of lung cancer cases that occur in women in the U.S. and 9% of cases in men are diagnosed in never-smokers."1

What do data trends show us?

Most patients who have never smoked are not diagnosed with lung cancer until they are in advanced stages, however, when lung cancer is unlikely to be treated by surgery. Why is this the case? Current screening guidelines for lung cancer, which involve low dose CT scans, only include people between 50 and 80 years old who have smoked at least 20 pack-years and who are still smoking or stopped less than 15 years ago. While this is the portion of the population currently designated as “high risk”, there are many other risk factors associated with lung cancer in addition to smoking, such as family history, radon exposure, and air pollution.

Screening for lung cancer is so important because when discovered at an early stage, there is a high potential for a cure. Given the increased percentages of patients who are being diagnosed with lung cancer these days who do not smoke, it seems like it might be time to reconsider and expand low-dose CT screening guidelines.

Findings from the TALENT study

At the latest World Conference on Lung Cancer, results for the TALENT study were presented. The TALENT study is a Taiwanese study that looked at low dose CT-screening “in a pre-defined, never-smoker, high-risk population”2 including people with lung cancer family history, exposure to secondhand smoke or cooking with poor ventilation, and those with tuberculosis or COPD. Out of 12,011 participants, the study was able to diagnose lung cancer in 313 people, 96.5% of whom were determined to have stage I disease and eligible for curative surgery.

In addition to showing that low dose CT screening could be effective to diagnose lung cancer in Taiwanese people with risk factors other than smoking, the TALENT study also revealed a higher percentage rate of lung cancer in people with a family history of lung cancer as opposed to the other participants in the study. The more close relatives a participant had with lung cancer in the family, the higher the rate was of developing lung cancer.

What does this mean?

What does this mean? In Taiwan, the doctor leading the TALENT study plans to create a new “risk score predictor” to determine who should be considered eligible for low dose CT screening, including risk factors such as family history and the other factors in the study. I think a similar study needs to be performed in the United States to access the feasibility for diagnosing lung cancer here through low dose CT scans; our risk factors in the U.S. are somewhat different from those in Taiwan, but studying them might reveal similar results and a need for a new “risk score predictor.”

If we could expand our eligibility criteria for screening, we could make a significant difference in shifting lung cancer diagnoses to earlier stages, thus extending survival and reducing death rates.

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