Assessment of Selection Criteria for Low-Dose Lung Screening CT Among Asian Ethnic Groups in Taiwan: From Mass Screening to Specific Risk-Based Screening for Non-Smoker Lung Cancer

• Published in: Clinical lung cancer Vol. 17; no. 5; pp. e45 - e56
• Main Authors: Wu, Fu-Zong, Huang, Yi-Luan, Wu, Carol C., Tang, En-Kuei, Chen, Chi-Shen, Mar, Guang-Yuan, Yen, Yu, Wu, Ming-Ting
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2016
• Subjects: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Asian Continental Ancestry Group - statistics & numerical data; Early Detection of Cancer - methods; Ethnic Groups - statistics & numerical data; Female; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Humans; Logistic Models; Lung cancer; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - epidemiology; Lung Neoplasms - pathology; Lung-RADS; Male; Mass Screening - methods; Middle Aged; Patient Selection; Pulmonary/Respiratory; Retrospective Studies; Risk Factors; Screening criteria; Sex Factors; Smoking; Taiwan - epidemiology; Tomography, X-Ray Computed - methods; Adenocarcinoma; Lung-RADS; Lung cancer; Screening criteria; Smoking; chest radiography; screening; part-solid nodules; VATS; PACS; United States; non-smoker; DLP; LDCT; PSNs; lung cancer; FBP; odds ratios; PGGNs; The ACR Lung Imaging Reporting and Data System; computed tomography; dose length product; OR; CI; adenocarcinoma; pure groundglass nodules; low dose CT (LDCT); low dose CT; picture archiving and communication system; CT; National Lung Screening Trial; filtered back projection; confidence interval; NLST; U.S; CXR; video-assisted thoracoscopic surgery; COPD; chronic obstructive pulmonary disease
• ISSN: 1525-7304; 1938-0690; 1938-0690
• DOI: 10.1016/j.cllc.2016.03.004

We aim to investigate the impact of applying the NLST eligibility criteria to the population in Taiwan, and to identify additional risk factors to select subjects at risk of lung cancer. Our findings suggest that female gender and a family history of lung cancer are two important predictor. A prospective study design based on survival analysis in non-smoker lung cancer screening is warranted. The National Lung Screening Trial (NLST) showed low-dose screening chest computed tomography (CT) reduced the lung cancer mortality rate up to 20% in high-risk patients in the United States. We aimed to investigate the impact of applying the NLST eligibility criteria to the population in Taiwan, and to identify additional risk factors to select subjects at risk for lung cancer. We retrospectively reviewed the medical records of 1763 asymptomatic healthy subjects (age range, 40-80 years) who voluntarily underwent low-dose chest CT (1029 male, 734 female) from August 2013 to August 2014. Clinical information and nodule characteristics were recorded. The results of subsequent follow-up and outcome were also recorded. A total of 8.4% (148/1763) of subjects would have been eligible for lung cancer screening based on the NLST criteria. However, only 1 of these eligible subjects would have a lung cancer detected at baseline. Among the 1615 subjects who did not meet the NLST criteria, the detection rates of lung cancer were 2.6% in women and 0.56% in men. Logistic regression showed that female gender and a family history of lung cancer were the 2 most important predictors of lung cancer in Taiwan (odds ratio, 6.367; P = .003; odds ratio, 3.017; P = .016, respectively). In conclusion, NLST eligibility criteria may not be effective in screening for lung cancer in Taiwan. A risk-based prediction model based on the family history of lung cancer and female gender can potentially improve the efficiency of lung cancer screening programs in Taiwan.