INDUSTRY ESSENTIALS
Sketching the roadmap for Asian lung cancer management: Expert consensus on lung cancer screening practices in Asian populations
Lung cancer (LC) is regarded as the most lethal form of cancer in Asia.1 In 2020, the World Health Organization (WHO) ’s Global Cancer Observatory (GLOBOCAN) estimated that 60% of global LC cases and 62% of global LC-related mortality were from Asian countries.1 With such alarming statistics, a timely diagnosis for LC becomes of utmost importance since early-stage LC is acquiescent towards treatment.1 According to the International Early Lung Cancer Action Program (I-ELCAP), a staggering 10-year survival rate of 92% was observed in stage I LC patients who underwent surgical resection within 1 month after diagnosis, further assuring the importance of early detection for LC.1
Despite the existence of guidelines on LC screening, these recommendations are targeted towards Western populations, which are composed of Caucasian patients.1 Since there are discernible epidemiological differences in LC between European and Asian countries, the current LC screening clinical guidelines may not apply to Asian populations.1 In particular, the epidemiology of LC in Asia is characterized by an elevated proportion of non-smokers (up to 33%), an early age of onset (≤45 years old), and a higher prevalence of epidermal growth factor receptor (EGFR) mutations (40%-55% in Asians vs. 15% -25% in Caucasians).1 As such, there is a need for LC screening practices tailored towards Asian populations.
Multiple virtual meetings of the Steering Committee (SC), composed of 19 LC experts from 11 Asian countries, were commenced to draft a series of LC screening recommendations dedicated to Asian countries.1 Throughout the SC meetings, the members discussed the strategies to implement LC screening practices that are tailored towards the ‘at-risk’ population with considerations for resource availability of local health care systems in mind.1
The consensus recommendations for LC screening in Asian countries
| Risk factors for LC | |
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1 |
Smoking history quantified in pack-years, is the most prominent risk factor for LC among smokers |
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2 |
In never-smokers, family history of LC, especially among first-degree relatives, is a risk factor for LC |
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3 |
Risk factors for LC and the distribution of driver mutations in patients with LC may vary across countries |
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4 |
History of pulmonary TB should be considered as an independent risk factor for LC, especially in high TB burden countries in Asia Pacific |
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5 |
Asbestos exposure and biomass fuel exposure have a significant association with LC in certain regions |
| LC screening criteria and interval | |
| 1 |
While selecting high-risk patients for LDCT screening, smoking history and age must be taken into consideration. This assessment of risk on the basis of age and pack-year smoking history has also been recommended by USPSTF:
In addition to the above USPSTF criteria,
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| 2 |
The frequency of LDCT screening should be usually every year for high-risk patients and should not exceed >2 years. Those with any detected abnormality should be followed up between 6 and 12 months with reference to Lung-RADS or Fleischner Society guidelines |
| 3 |
Discontinue screening in individuals who are >80 years old |
| LC screening methodology and related programs | |
| 1 |
LDCT screening is recommended for high-risk individuals (according to the smoking history, years since smoking cessation, family history of cancer, etc.), annually or biannually |
| 2 |
Implementation of risk prediction models and AI-supportive modalities to boost the efficacy of screening and follow-up with LDCT |
| 3 |
Incorporation of smoking cessation programs along with the LC screening program is necessary |
| 4 |
Improve access to LC screening programs and subsequent health care |
| Lung nodule management and surveillance | |
| 1 |
The updated Fleischner guidelines (2018) are recommended for IPN management and follow-up procedures in Asians |
| 2 |
For the reporting of radiological parameters in LC screening programs, Lung-RADS or modified Lung-RADS is recommended |
| 3 |
Involvement of a multidisciplinary team for LC screening and management of IPN is recommended |
AI: Artificial intelligence; IPN: Incidental pulmonary nodules; LC: Lung cancer; LDCT: Low-dose computed tomography; Lund-RADS: The American College of Radiology Lung Computed Tomography Screening Reporting and Data System guidelines; TB: Tuberculosis; USPSTF: The United States Preventive Services Task Force
