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Lung-cancer screening in at-risk never-smokers catches early disease

IASLC World Conference on Lung Cancer
Reuters Health - 03/02/2021 - A study from Taiwan supports the value of low-dose computed tomography (LDCT) lung cancer screening in people who have never smoked but have risk factors for lung cancer.

The Taiwan Lung Cancer Screening for Never Smoker Trial (TALENT) detected lung cancer in 2.6% of never-smokers, which is more than the 1.1% and 0.9% lung-cancer detection rates from the U.S. National Lung Screening Trial (NLCST) and the NELSON trial, respectively, which screened heavy smokers.

Dr. Pan-Chyr Yang of the National Taiwan University College of Medicine, in Taipei, reported the findings at the International Association for the Study of Lung Cancer (IASLC) virtual World Conference on Lung Cancer.

In Taiwan, lung cancer is the leading cause of cancer mortality, and 53% of these deaths occur in people who have never smoked. Lung cancer among never-smokers in East Asia represents a distinct disease: The genomic profile, carcinogenesis and pattern of progression are different when compared with individuals who smoke, Dr. Yang noted in his presentation.

In heavy smokers, LDCT screening catches lung cancer early and reduces mortality.

The TALENT study was designed to gauge the benefit of LDCT in never-smokers. It enrolled more than 12,000 adults between age 55 and 75 years, who had never smoked but had one of the following risk factors for lung cancer: family history of lung cancer (50%), passive smoke exposure, tuberculosis or chronic lung disease, cooking without ventilation and a cooking index of 110 or greater (defined as 2/7 times the number of days of frying per week times the number of years cooking).

Three hundred and thirteen patients (2.6%) had lung cancer detected by screening. The prevalence of lung cancer was 3.2% in those with a family history of lung cancer and 2.0% in those without a family history of lung cancer (P<0.001).

The risk of lung cancer increased with the number of first-degree relatives with lung cancer (from 2.0% with none to 9.1% with four or more).

"Most importantly," 96.5% of patients were diagnosed with stage-0 or -1 lung cancer, which is "potentially curable by surgery," Dr. Yang said in a statement.

The TALENT study, he said, shows that LDCT lung-cancer screening "may be feasible" in never-smokers with risk factors for lung cancer.

Dr. Yang and his team plan to develop a risk score predictor that includes the family history, and genetic and environmental factors to help identify high-risk non-smoking population who may benefit from LDCT screening for lung cancer.

"This study paves the way to additional studies in this unique group of high-risk individuals in order to maximize the benefits of early detection of lung cancer," IASLC interim chief scientific officer Dr. Giorgio Scagliotti, University of Torino, Italy, said in the news release.

SOURCE: https://wclc2020.iaslc.org/ IASLC World Conference on Lung Cancer, held January 28-31, 2021.

By Megan Brooks

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