TY - JOUR
T1 - Screening for Lung Cancer in Individuals Who Never Smoked
T2 - An International Association for the Study of Lung Cancer Early Detection and Screening Committee Report
AU - members of the Diagnostics Working Group
AU - ED and Screening Committee
AU - Kerpel-Fronius, Anna
AU - Tammemägi, Martin
AU - Cavic, Milena
AU - Henschke, Claudia
AU - Jiang, Long
AU - Kazerooni, Ella
AU - Lee, Choon Taek
AU - Ventura, Luigi
AU - Yang, Dawei
AU - Lam, Stephen
AU - Huber, Rudolf M.
AU - Zulueta, Javier
AU - Viola, Lucia
AU - Mohan, Anant
AU - Schmidt, Heidi
AU - Sales dos Santos, Ricardo
AU - Sozzi, Gabriella
AU - Huber, Rudolf
N1 - Funding Information:
The authors thank the International Association for the Study of Lung Cancer for supporting the Early Detection and Screening Committee and for supporting the development of this manuscript. The authors also acknowledge Patient Advocate representatives Mrs. Jill Feldman and Kristin Ito for careful review of this manuscript. Disclosure: Dr. Henschke is a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on computed tomography scans of the chest which are owned by Cornell Research Foundation. Since 2009, Dr. Henschke does not accept any financial benefit from these patents including royalties and any other proceeds related to the patents or patent applications owned by the Cornell Research Foundation. Dr. Henschke is the President and serves on the board of the Early Diagnosis and Treatment Research Foundation. Dr. Henschke receives no compensation from the Foundation. The Foundation is established to provide grants for projects, conferences, and public databases for research on early diagnosis and treatment of diseases. Recipients include International - Early Lung Cancer Action Program, among others. The funding comes from a variety of sources including philanthropic donations, grants, and contracts with agencies (federal and nonfederal) and imaging and pharmaceutical companies relating to image processing assessments. The various sources of funding exclude any funding from tobacco companies or tobacco-related sources. The remaining authors declare no conflict of interest.
Publisher Copyright:
© 2021 International Association for the Study of Lung Cancer
PY - 2022/1
Y1 - 2022/1
N2 - Screening with low-dose computed tomography of high-risk individuals with a smoking history reduces lung cancer mortality. Current screening guidelines and eligibility criteria can miss more than 50% of lung cancers, and in some geographic areas, such as East Asia, a large proportion of the missed lung cancers are in never-smokers. Although randomized trials revealed the benefits of screening for people who smoke, these trials generally excluded never-smokers. Thus, the feasibility and effectiveness of lung cancer screening of individuals who never smoked are uncertain. Several known and suspected risk factors for lung cancers in never-smokers such as exposure to secondhand smoke, occupational carcinogens, radon, air pollution, and pulmonary diseases, such as chronic obstructive pulmonary disease and interstitial lung diseases, and intrinsic factors, such as age, are well noted. In this regard, knowledge of risk factors may make possible quantification and prediction of lung cancer risk in never smokers. It is worth considering if and how never smokers could be included in population-based screening programs. As the implementation of these programs is challenging in many countries owing to multiple factors and the epidemiologic differences by global regions, these issues will need to be evaluated in each country taking into account various factors, including accuracy of risk assessment and cost-effectiveness of screening in never smokers. This report aims to outline current knowledge on risk factors for lung cancer in never smokers to propose research strategies for this topic and initiate a broader discussion on lung cancer screening of never smokers. Similar considerations can be made in current and ex-smokers, which do not fulfill the current screening inclusion criteria, but otherwise are at increased risk. Although screening of never smokers may in the future be effectively conducted, current evidence to support widespread implementation of this practice is lacking.
AB - Screening with low-dose computed tomography of high-risk individuals with a smoking history reduces lung cancer mortality. Current screening guidelines and eligibility criteria can miss more than 50% of lung cancers, and in some geographic areas, such as East Asia, a large proportion of the missed lung cancers are in never-smokers. Although randomized trials revealed the benefits of screening for people who smoke, these trials generally excluded never-smokers. Thus, the feasibility and effectiveness of lung cancer screening of individuals who never smoked are uncertain. Several known and suspected risk factors for lung cancers in never-smokers such as exposure to secondhand smoke, occupational carcinogens, radon, air pollution, and pulmonary diseases, such as chronic obstructive pulmonary disease and interstitial lung diseases, and intrinsic factors, such as age, are well noted. In this regard, knowledge of risk factors may make possible quantification and prediction of lung cancer risk in never smokers. It is worth considering if and how never smokers could be included in population-based screening programs. As the implementation of these programs is challenging in many countries owing to multiple factors and the epidemiologic differences by global regions, these issues will need to be evaluated in each country taking into account various factors, including accuracy of risk assessment and cost-effectiveness of screening in never smokers. This report aims to outline current knowledge on risk factors for lung cancer in never smokers to propose research strategies for this topic and initiate a broader discussion on lung cancer screening of never smokers. Similar considerations can be made in current and ex-smokers, which do not fulfill the current screening inclusion criteria, but otherwise are at increased risk. Although screening of never smokers may in the future be effectively conducted, current evidence to support widespread implementation of this practice is lacking.
KW - Early detection
KW - Epidemiology
KW - Low-dose computed tomography
KW - Lung cancer
KW - Never-smokers
KW - Screening
UR - http://www.scopus.com/inward/record.url?scp=85116228648&partnerID=8YFLogxK
U2 - 10.1016/j.jtho.2021.07.031
DO - 10.1016/j.jtho.2021.07.031
M3 - Article
C2 - 34455065
AN - SCOPUS:85116228648
SN - 1556-0864
VL - 17
SP - 56
EP - 66
JO - Journal of Thoracic Oncology
JF - Journal of Thoracic Oncology
IS - 1
ER -