Community-based lung cancer screening with low-dose CT in China: Results of the baseline screening

doi:10.1016/j.lungcan.2018.01.003

Lung Cancer

Volume 117, March 2018, Pages 20-26

https://doi.org/10.1016/j.lungcan.2018.01.003 Get rights and content

Highlights

•
A community-based screening for lung cancer in a Chinese population.
•
LDCT led to a 74.1% increase in detecting early-stage lung cancer.
•
Non-smoking related risk factors of lung cancer in the Chinese population.

Abstract

Objectives

To investigate whether low-dose computed tomography (LDCT) screening is capable of enhancing the detection rate of early-stage lung cancer in high-risk population of China with both smoking and non-smoking related factors.

Methods

From 2013–2014, eligible participants with high-risk factors of lung cancer were randomly assigned to a screening group or a control group with questionnaire inquiries. Any non-calcified nodules or masses with longest diameters of ≥4 mm identified on LDCT images were considered as positive.

Results

A total of 6717 eligible participants were randomly enrolled to a study group (3550 to LDCT screening and 3167 to standard care). 3512 participants (98.9%) underwent LDCT screening, and 3145 participants (99.3%) received questionnaire inquiries. A positive screening result was observed in 804 participants (22.9%). In the two-year follow-up period, lung cancer was detected in 51 participants (1.5%) in the LDCT group versus 10 (0.3%) in the control group (stage I: 48 vs 2; stage II to IV or limited stage: 3 vs 8), respectively. Early-stage lung cancer was found in 94.1% vs 20%, respectively.

Conclusions

Compared to usual care, LDCT led to a 74.1% increase in detecting early-stage lung cancer. This study provides insights about the non-smoking related risk factors of lung cancer in the Chinese population.

Introduction

In China, lung cancer is now the most common cancer and the first cause of cancer mortality. An estimated 704,800 new lung cancer cases and 569,400 lung cancer deaths occurred in 2012, accounting for about 19.7% of total cancer diagnoses and 26.0% of total cancer deaths [1]. Most new lung cancer cases and cancer deaths occur in the age range from 45 to 74 years. In addition, an upward trend in age-standardized incidence rates was observed for lung cancers in female, compared to a stable trend in male [2].

Currently, no definitive biomarker or genetic factor has been identified for the prediction or the early diagnosis of lung cancer. Low-dose computed tomography (LDCT) has been applied as a promising approach for lung cancer screening according to the National Lung Cancer Screening Trial (NLST) [3]. LDCT showed better performance for the detection of early-stage lung cancer than chest X-ray and demonstrated a significant reduction in lung cancer-related mortality mainly due to detection at earlier stages when applied to a high-risk population, which is often defined by age and smoking.

An estimated 15% of male lung cancer and 53% of female lung cancer (25% of all cases) are not attributable to tobacco use [4]. Epidemiology studies identified that lung cancer in never smokers occurs more frequently in female than in male. The proportion of female lung cancer is particularly high in China despite a lower prevalence of smoking [5]. Striking differences in the epidemiological, environmental exposures and molecular characteristics arising in the Chinese population have not been clearly identified yet. This strongly highlights the need for additional research in smoking as well as in non-smoking related risk factors for lung cancer in China. Unfortunately, no reliable information for selecting the screening population in China is currently available.

The paper describes the baseline screening results of trial conducted as a randomized controlled study in a Chinese population with a high risk of lung cancer.

Section snippets

Study design

This study is a prospective randomized controlled trial. It was approved by the Ethics Committee of Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China (No. KS1407). Written informed consent was obtained from every patient participating in this research when they were enrolled. The primary aim of this study is to evaluate the efficiency of LDCT in lung cancer detection in asymptomatic high-risk population. The second aim is to evaluate the impact of LDCT on lung

Results

A total of 6717 participants were recruited, of which 8 participants were excluded because they had lung cancer before enrollment, 50 declined to participate, and 2 underwent incorrect screening, respectively. Of the remaining 6657 participants, 3512 (52.8%) were randomized to screening by LDCT, and 3145 (47.2%) were assigned to the control group. Fig. 1 describes the inclusion process in detail.

LDCT was performed in 98.9% (3512/3550) of the participants in the LDCT group. Women represented

Discussion

In this randomized controlled study of low-dose CT screening, we estimated the detection rate of lung cancer by LDCT in a Chinese population with high-risk factors.

The prevalence of positive results in lung cancer screening with the use of LDCT in the present study was 22.9%, which was similar to the results of previous studies (20.8% in NELSON [9], 23% in ELCAP [10], 27.3% in NLST [3] and 30.3% in ITALUNG) [11]). After a two-year follow-up, 51 (1.5%) of 3512 screened participants were

Conclusion

In this study, at baseline, we found that non-calcified nodules ≥4 mm would be detected in 22.9% of the 3512 participants on baseline low-dose CT and that approximately 6.3% (51 of 804) of these would be malignant. The detection at an earlier stage represents a stage shift and subsequently a probable mortality rate reduction in the future. Compared to standard care, LDCT led to a 74.1% increase in detecting early-stage lung cancer. More importantly, we explored a novel risk classification

Conflict of interest

The authors have no conflicts of interest to declare.

Financial disclosures

This work was supported by Program of Joint Effort for Tackling Major Diseases of Shanghai Health System (Grant No. 2013ZYJB0402), Shanghai Chest Hospital Science and Technology Development Fund (Grant No. YZ2015-ZX) and Innovation fund of Shanghai Pudong New Area Science and Technology Development Commission (Grant No. PKJ2014-S22).

Conflict of interest statement

We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled “Community-based lung cancer screening with low-dose CT in China: results of the baseline screening”. The authors declared that they

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¹: These contributed equally to this work.

View full text

Community-based lung cancer screening with low-dose CT in China: Results of the baseline screening

Highlights

Abstract

Objectives

Methods

Results

Conclusions

Introduction

Section snippets

Study design

Results

Discussion

Conclusion

Conflict of interest

Financial disclosures

Conflict of interest statement

Chin. J. Cancer

J. Thorac. Oncol.

Lancet

Lung Cancer

J. Thorac. Oncol.

Lung Cancer

J. Thorac. Oncol.

Lancet

Lung Cancer

Toxicol. In Vitro

Lung Cancer

J. Thorac. Oncol.

Lancet Respir. Med.

Lung Cancer

Cancer statistics in China, 2015

CA Cancer J. Clin.

Results of initial low-dose computed tomographic screening for lung cancer

N. Engl. J. Med.

Global cancer statistics, 2002

CA Cancer J. Clin.

Global cancer statistics, 2012

CA Cancer J. Clin.

NCCN Clinical Practice Guidelines in Oncology: Lung Cancer Screenig

The 2015 world health organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification

J. Thorac. Oncol.

Management of lung nodules detected by volume CT scanning

N. Engl. J. Med.

Software volumetric evaluation of doubling times for differentiating benign versus malignant pulmonary nodules

AJR Am. J. Roentgenol.

Estimating overdiagnosis in low-dose computed tomography screening for lung cancer: a cohort study

Ann. Intern. Med.

Annual or biennial CT screening versus observation in heavy smokers: 5-year results of the MILD trial

Eur. J. Cancer Prev.

Randomized study on early detection of lung cancer with MSCT in Germany: study design and results of the first screening round

J. Cancer Res. Clin. Oncol.

Mutational and epigenetic evidence for independent pathways for lung adenocarcinomas arising in smokers and never smokers

Cancer Res.

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Radiology