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Lung Cancer Screening in Asia: An Expert Consensus Report

Lam DC 1 , Liam CK 2 , Andarini S 3 , Park S 4 , Tan DSW 5 , Singh N 6 Show all authors , Jang SH 7 , Vardhanabhuti V 8 , Ramos AB 9 , Nakayama T 10 , Nhung NV 11 , Ashizawa K 12 , Chang YC 13 , Tscheikuna J 14 , Van CC 15 , Chan WY 16 , Lai YH 17 , Yang PC 18

Affiliations 

  • 1 Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
  • 2 Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 3 Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia - Persahabatan Hospital, Jakarta, Indonesia
  • 4 Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
  • 5 Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Division of Medical Oncology, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore
  • 6 Lung Cancer Clinic, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
  • 7 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
  • 8 Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, People's Republic of China
  • 9 Department of Thoracic Surgery and Anesthesia, Lung Center of the Philippines, Quezon City, Philippines
  • 10 Division of Screening Assessment and Management, National Cancer Center Institute for Cancer Control, Japan
  • 11 Vietnam National Lung Hospital, University of Medicine and Pharmacy, VNU Hanoi, Vietnam
  • 12 Department of Clinical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
  • 13 Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
  • 14 Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 15 Vietnam National Lung Hospital, Hanoi, Vietnam
  • 16 Imaging Department, Gleneagles Hospital Kuala Lumpur, Jalan Ampang, 50450 Kuala Lumpur; Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia
  • 17 School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Cancer Center, Taipei, Taiwan
  • 18 Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan & National Taiwan University Hospital, Taipei, Taiwan. Electronic address: pcyang@ntu.edu.tw
J Thorac Oncol, 2023 Oct;18(10):1303-1322.
PMID: 37390982 DOI: 10.1016/j.jtho.2023.06.014

Abstract

INTRODUCTION: The incidence and mortality of lung cancer are highest in Asia compared with Europe and USA, with the incidence and mortality rates being 34.4 and 28.1 per 100,000 respectively in East Asia. Diagnosing lung cancer at early stages makes the disease amenable to curative treatment and reduces mortality. In some areas in Asia, limited availability of robust diagnostic tools and treatment modalities, along with variations in specific health care investment and policies, make it necessary to have a more specific approach for screening, early detection, diagnosis, and treatment of patients with lung cancer in Asia compared with the West.

METHOD: A group of 19 advisors across different specialties from 11 Asian countries, met on a virtual Steering Committee meeting, to discuss and recommend the most affordable and accessible lung cancer screening modalities and their implementation, for the Asian population.

RESULTS: Significant risk factors identified for lung cancer in smokers in Asia include age 50 to 75 years and smoking history of more than or equal to 20 pack-years. Family history is the most common risk factor for nonsmokers. Low-dose computed tomography screening is recommended once a year for patients with screening-detected abnormality and persistent exposure to risk factors. However, for high-risk heavy smokers and nonsmokers with risk factors, reassessment scans are recommended at an initial interval of 6 to 12 months with subsequent lengthening of reassessment intervals, and it should be stopped in patients more than 80 years of age or are unable or unwilling to undergo curative treatment.

CONCLUSIONS: Asian countries face several challenges in implementing low-dose computed tomography screening, such as economic limitations, lack of efforts for early detection, and lack of specific government programs. Various strategies are suggested to overcome these challenges in Asia.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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