Findings from the Taiwan National Lung Cancer Early Detection Program have shown that lung cancer screening by low-dose computed tomography (CT) can detect tumors at an early-enough phase to allow for effective intervention. In a recent analysis, 85% of tumors detected by screening were stage 0 or I and therefore potentially curable. Furthermore, these tumors were found mostly in nonsmokers with a positive family history, investigators reported at the International Association for the Study of Lung Cancer 2023 World Conference on Lung Cancer.1
Pan-Chyr Yang, MD, PhD
The results of the Taiwan National Lung Cancer Early Detection Program and The Taiwan Lung Cancer Screening for Never-Smoker Trial (TALENT) were presented at a press briefing by Pan-Chyr Yang, MD, PhD, Professor and Chair of the Department of Internal Medicine at the National Taiwan University Hospital, and at the Presidential Plenary by Chi-Yen Huang, PhD, of Taiwan’s Health Promotion Administration, Ministry of Health and Welfare.
The investigators highlighted the urgent need to reduce global lung cancer mortality. Asia has the highest lung cancer burden in the world, marked by a 60% incidence and a 62% mortality rate. Although heavy smoking is an established risk factor for lung cancer, the disease may still occur in nonsmokers, especially in women in Asia. Globally, almost one-third of patients with lung cancer are nonsmokers; in Taiwan, two-thirds are nonsmokers. The existing screening criteria in the United States and South Korea limit eligibility to heavy smokers alone, leaving a substantial portion of the at-risk population not eligible for screening, the speakers noted.
“To reduce lung cancer mortality, we need to expand the screening eligibility to cover nonsmoking lung cancer,” Dr. Yang said. “Meta-analyses and cost-effectiveness studies support low-dose CT screening in nonsmokers.”
Family history figures strongly in the risk of lung cancer among nonsmokers, according to earlier findings from TALENT, which showed a 1.6-fold risk in adults with a family history (article in press). Analysis of 1,102 screened individuals who had a family history of lung cancer showed an overall detection rate of 4.5% at 10 years, but the rate rose to 7.4% for individuals who had several relatives with lung cancer. Risk was highest among persons with relatives on the maternal side.2
Program Details
The Taiwan Early Detection Program for Lung Cancer, which uses low-dose CT imaging, aims to double the identification of stage I disease and the 5-year survival rate by the year 2030. Building on the knowledge gained from the TALENT trial, Taiwan launched this national lung cancer screening program in July 2022, targeting two populations:
1. Individuals with a family history of lung cancer: Specifically, this group entails men between the ages of 50 and 74 and women between the ages of 45 and 74, whose parents, children, or siblings have been diagnosed with lung cancer. Nonsmoking lung cancer is more prevalent among females. The histology in this population is often adenocarcinoma, and in this subset, nearly 90% are nonsmokers, and 10% are light smokers, according to Dr. Yang.
2. Individuals with a history of heavy smoking: Specifically, this group includes individuals between the ages of 50 and 74 with a smoking history of 30 or more pack-years, who are willing to quit smoking or have quit within the past 15 years.
The screening program uses a modified Lung-RADS guideline issued by the American College of Radiology for nodule management. It established a case management system to ensure appropriate follow-up of positive screening results. The collected data include risk factors, image interpretation results, and evaluation outcomes, which are used to facilitate timely diagnosis and treatment.
Preliminary Results
A total of 49,508 individuals were screened between July 2022 and June 2023, with 28,617 (58%) having a family history of lung cancer and 18,970 (38%) being heavy smokers. Preliminary results for this 1 year of screening have been promising, the investigators reported. Of the 49,508 persons screened, 4,406 (9%) had a positive screening (ie, suspicious) result, and 531 (1.1%) were ultimately diagnosed with lung cancer.
The cancer detection rate was 1.4% among persons with a family history of lung cancer, 0.6% among heavy smokers, and 0.9% among the 1,921 individuals with both risk factors. About 85% of lung cancer cases were diagnosed at an early stage, ie, stage 0 or I.
“The detection rate of individuals with a family history of lung cancer was the highest, which warrants inviting more first-degree relatives of lung cancer cases to be screened,” Dr. Huang said.
“The Taiwan National Lung Cancer Early Detection Program is a significant step forward in the fight against lung cancer, offering hope for saving lives through early detection and improved treatment outcomes,” Dr. Yang said. Dr. Huang noted the group’s ongoing work in developing artificial intelligence–based automatic lung nodule detection algorithms, which should make identification of cases more accurate and their interpretation less expensive.
DISCLOSURE: Dr. Yang and Dr. Huang reported no conflicts of interest.
REFERENCES
1. Huang KP, Huang CY, Hsieh PC, et al: The national early detection program for lung cancer in Taiwan. 2023 World Conference on Lung Cancer. Abstract PL03.04. Presented September 11, 2023.
