Screening for Lung Cancer in Individuals Who Never Smoked: An International Association for the Study of Lung Cancer Early Detection and Screening Committee Report

Yang, Dawei; Zulueta, Javier; Viola, Lucia; Lee, Choon–Taek; Čavić, Milena; Schmidt, Heidi; Kazerooni, Ella A.; Santos, Ricardo Sales dos; Klinke, Anna; Henschke, Claudia I.; Ventura, Luigi; Jiang, Long; Sozzi, Gabriella; Tammemägi, Martin C.; Lam, Stephen; Huber, Rudolf M.

doi:10.1016/j.jtho.2021.07.031

Cited by 67 publications

(54 citation statements)

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“…There are currently no guidelines to recommend lung cancer screening in non‐smokers, as the feasibility and effectiveness of these programs are still uncertain. The challenge lies in identifying never‐smokers with risk factors for lung cancer who would benefit from screening 5 . It is important for general practitioners and general physicians to be aware that NSCLC may present in a diverse manner and, importantly, to consider a differential of NSCLC in young, non‐smoking patients who present with acute and/or atypical respiratory symptoms.…”

Section: Discussionmentioning

confidence: 99%

Lung cancer in non‐smokers: a diagnosis of increasing importance

Dean

Lennox

Senko

et al. 2022

Medical Journal of Australia

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Section: Discussionmentioning

confidence: 99%

Lung cancer in non‐smokers: a diagnosis of increasing importance

Dean

Lennox

Senko

et al. 2022

Medical Journal of Australia

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“…This highlights the importance of having risk models developed specifically for this population. The International Association of Lung Cancer Study (IASLC) recently released a statement specifically focused on never smokers, in which it emphasizes the importance of risk-based screening for never smokers (18).…”

Section: Discussionmentioning

confidence: 99%

Asian Lung Cancer Absolute Risk Models for lung cancer mortality based on China Kadoorie Biobank

Warkentin

Tammemägi

Espin-Garcia

et al. 2022

Preprint

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BackgroundLung cancer is the leading cause of cancer mortality globally. Early detection through screening can markedly improve prognosis and prediction models can identify high-risk individuals for screening. However, most models have been developed in North American cohorts of smokers and much less is known about risk factors for never-smokers, which represent a growing proportion of lung cancers, particularly for Asian populations.MethodsBased on the China Kadoorie Biobank, a population-based prospective cohort study of 512,714 adults age 30-79 recruited between 2004-2008 with up to 12 years of follow-up, we built an Asian Lung Cancer Absolute Risk Model (ALARM) for lung cancer mortality using flexible parametric survival models, separately for ever- and never-smokers. Model performance was evaluated in a 25% held-out test set using the time-dependent area under the receiver operating characteristic curve (AUC) and by comparing the model-predicted and observed risks for agreement (i.e. calibration).ResultsPredictors assessed in the never-smoker lung cancer mortality model were age, sex, household income, lung function, history of emphysema/bronchitis, family history of cancer, personal cancer history, BMI, passive smoking, and indoor air pollution. The ever-smoker model additionally assessed smoking status (former vs. current), duration, intensity, and years since cessation. The 5-year AUC based on the hold-out test set for the never and ever-smoker models were 0.77 (95% CI: 0.73-0.81) and 0.81 (95% CI: 0.79-0.84), respectively. The maximum 5-year risk for never and ever smokers were 2.7% and 14.0%, respectively.ConclusionsThis study is among the first to develop and test risk models specifically for Asian population, separately for never (ALARM-NS) and ever-smokers (ALARM-ES). Our models identify Asian never- and ever-smokers at high-risk of death due to lung cancer with a high degree of accuracy, and may identify those with risks exceeding common eligibility thresholds who would likely benefit from lung cancer screening.

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“…For asbestos-exposed workers who never smoked but who have one or more other lung cancer risk factors, including asbestos-related parenchymal or pleural fibrosis; chronic obstructive or interstitial lung disease; a family history of lung cancer; a personal history of cancer; or exposure to multiple occupational lung carcinogens, offering LDCT should also be strongly considered [ 56 , 57 ]. Whether LDCT screening should be offered to workers exposed to asbestos but who have never smoked and have no other risk factors depends on the threshold level of lung cancer risk at which LDCT screening is justified, an area of evolving research and consensus [ 58 , 59 , 60 ] Kerperl-Fronius 2022; ten Haaf 2022; Tammemägi 2014).…”

Section: Current Challenges To Application Of Ldct Among Aepmentioning

confidence: 99%

Lung Cancer Screening in Asbestos-Exposed Populations

Markowitz

2022

IJERPH

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Asbestos exposure is the most important cause of occupational lung cancer mortality. Two large randomized clinical trials in the U.S. and Europe conclusively demonstrate that annual low-dose chest CT (LDCT) scan screening reduces lung cancer mortality. Age and smoking are the chief risk factors tested in LDCT studies, but numerous risk prediction models that incorporate additional lung cancer risk factors have shown excellent performance. The studies of LDCT in asbestos-exposed populations shows favorable results but are variable in design and limited in size and generalizability. Outstanding questions include how to: (1) identify workers appropriate for screening, (2) organize screening programs, (3) inform and motivate people to screen, and (4) incorporate asbestos exposure into LDCT decision-making in clinical practice. Conclusion: Screening workers aged ≥50 years with a history of ≥5 years asbestos exposure (or fewer years given intense exposure) in combination with either (a) a history of smoking at least 10 pack-years with no limit on time since quitting, or (b) a history of asbestos-related fibrosis, chronic lung disease, family history of lung cancer, personal history of cancer, or exposure to multiple workplace lung carcinogens is a reasonable approach to LDCT eligibility, given current knowledge. The promotion of LDCT-based screening among asbestos-exposed workers is an urgent priority.

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Screening for Lung Cancer in Individuals Who Never Smoked: An International Association for the Study of Lung Cancer Early Detection and Screening Committee Report

Abstract: Screening with low-dose computed tomography of high-risk individuals with a smoking history reduces lung cancer mortality. Current screening guidelines and eligibility criteria can miss more than 50% of lung cancers, and in some geographic areas, such as East Asia, a large proportion

Cited by 67 publications

References 50 publications

Lung cancer in non‐smokers: a diagnosis of increasing importance

Lung cancer in non‐smokers: a diagnosis of increasing importance

Asian Lung Cancer Absolute Risk Models for lung cancer mortality based on China Kadoorie Biobank

Lung Cancer Screening in Asbestos-Exposed Populations

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