A study presented by researchers with the Ministry of Health and Welfare in Taiwan confirmed low-dose computed tomography (CT) screening may be feasible in a predefined, never-smoking, high-risk population. The research was presented at the International Association for the Study of Lung Cancer (IASLC) 2020 World Conference on Lung Cancer (WCLC) Singapore, which was moved to a virtual format and held January 28–31, 2021, in light of the COVID-19 pandemic (Abstract PS01.02).
In Taiwan, lung cancer is the leading cause of cancer mortality, and 53% of those who have died of lung cancer were never-smokers. The National Lung Cancer Screening Trial (NLCST) and NELSON trials demonstrated that the use of low-dose CT is effective for lung cancer screening; however, most of the lung cancer screenings focused on heavy smokers, which may not be suitable for an East Asian population, as this population tends to have higher incidence of lung cancer in never-smokers.
"The study revealed that low-dose CT screening for lung cancer in never-smokers with high risk may be feasible, which is very important to all who are fighting against lung cancer, [considering] the increasing global threat for lung cancer in never-smokers. Most importantly, the study showed that family history of lung cancer may increase the risk of lung cancer."— Pan Chyr Yang, MD, PhD
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TALENT Study Details
The researchers, led by Pan Chyr Yang, MD, PhD, of the National Taiwan University College of Medicine, developed the Taiwan Lung Cancer Screening for Never-Smoker Trial (TALENT), a nationwide lung cancer low-dose CT screening study focused on never-smokers. TALENT’s goal is also to develop an effective strategy for screening of lung cancer in never-smokers and establish a risk prediction model to identify high-risk population that may benefit from low-dose CT screening.
The TALENT study enrolled and followed 12,011 individuals between February 2015 and July 2019. Participants were between 55 and 75 years of age and never-smokers. In addition, participants needed to have one of the following risk factors for lung cancer: family history of lung cancer within the third-degree of relations; passive smoking exposure; tuberculosis or chronic obstructive pulmonary disease; cooking index of 110 or greater; and absence of ventilation during cooking.
Results
Of the 12,011 individuals, 6,009 (50%) had family history of lung cancer, and 2,094 (17.4%) were considered positive on screening. Of these, 395 participants (3.3%) underwent lung biopsies or surgeries. Lung cancer (2.6%) was diagnosed in 313 patients, with 255 (2.1%) diagnosed with invasive lung cancer—all but one was adenocarcinoma, and 96.5% were diagnosed with stage I disease. The remaining 81 patients had benign lung disease or a malignancy other than cancer.
The prevalence of lung cancer was 3.2% and 2.0% (P < .001) in participants with and without lung cancer family history, respectively. The prevalence of invasive lung cancer was 2.6% and 1.6%, respectively. The lung cancer risk increased with the number of first-degree relatives with lung cancer (0 = 2.0%, 1 = 3.1%, 2 = 4.0%, 3 = 6.7%, ≥ 4 = 9.1%; P < .001).
Dr. Yang noted that 96.5% patients were stage 0 or 1 and potentially curable by surgery. The study also demonstrated the high risk of family history, especially among participants with a first-degree family history of lung cancer.
“The study revealed that low-dose CT screening for lung cancer in never-smokers with high risk may be feasible, which is very important to all who are fighting against lung cancer, [considering] the increasing global threat for lung cancer in never-smokers. Most importantly, the study showed that family history of lung cancer may increase the risk of lung cancer,” he added.
Next Steps
Dr. Yang said his team plans to develop a risk score predictor that includes family history and genetic and environmental factors for identification of high-risk populations who can benefit from low-dose CT screening. A standard screening protocol will be established, and Dr. Yang and his team will advise the authority to formally implement low-dose CT for lung cancer screening in Taiwan.
“We hope the screening program can benefit patients suffering from lung cancer, especially in those countries with high incidence of lung cancer in never-smokers,” he said.
Disclosure: For full disclosures of the study authors, visit wclc2020.iaslc.org/disclosures.
