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Analysis led by Professors Jianxing He and Wenhua Liang from the First Affiliated Hospital of Guangzhou Medical College and the Nationwide Medical Analysis Middle for Respiratory Illness, specializing in lung most cancers screening methods, reveals that the non-risk-based (common) screening strategy—unrestricted by conventional high-risk standards—achieves a comparable detection charge of lung most cancers amongst people not labeled as high-risk relative to those that had been.
The Journal of the American Medical Affiliation (JAMA) revealed the examine titled “Non-Risk-Based Lung Cancer Screening With Low-Dose Computed Tomography.”
The findings underscore the need of evaluating the effectiveness of lung most cancers screening in non-high-risk populations and creating biomarker-based enrichment methods to refine pre-screening choice on this subgroup.
In 2015, the First Affiliated Hospital of Guangzhou Medical College, in collaboration with the Guangdong Hetaoxiang Medical Charity Basis and the Guangzhou Charity Affiliation, launched a community-based lung most cancers screening initiative concentrating on low-income and underserved populations.
Subsequently, with help from the Guangzhou Municipal Authorities, the Well being and Household Planning Fee, the Civil Affairs Bureau, and KingMed Diagnostics, the hospital and the Nationwide Medical Analysis Middle for Respiratory Illness undertook the “LUNG-CARE Project,” a large-scale lung most cancers screening initiative in Yuexiu District, Guangzhou.
By leveraging group networks, the mission supplied eligible residents with free low-dose computed tomography (LDCT) scans to advertise early analysis and therapy of lung most cancers.
Whereas randomized managed trials have proven that heavy people who smoke profit from LDCT screening, current research point out a rising incidence of lung most cancers amongst youthful, non-smoking populations in Asia.
The LUNG-CARE Venture integrated detailed epidemiologic questionnaires and follow-up protocols to establish potential danger components past smoking and to refine screening methods for the Chinese language inhabitants. A central intention was to check lung most cancers detection charges between people with and with out standard high-risk components (e.g., smoking or household historical past) and to uncover novel population-specific indicators of danger.
Between 2015 and 2021, residents aged 40–74 years with no historical past of lung most cancers or associated signs had been recruited from 4 communities in Guangzhou to endure LDCT-based screening. Lung most cancers detection charges, the proportion of early-stage (stage I) diagnoses, and the diagnostic efficiency of LDCT had been assessed. Individuals had been stratified into “high-risk” classes in line with the NCCN pointers and the Chinese language Medical Affiliation’s skilled consensus.
A complete of 11,708 individuals underwent LDCT screening [male: 5,452 (46.6%), female: 6,256 (53.4%), median age 59 years (IQR: 51-65)]. Constructive findings—outlined as stable or part-solid nodules ≥5 mm or pure ground-glass nodules ≥8 mm—had been noticed in 2,245 individuals (19.2%).
Of those, 231 underwent invasive diagnostic procedures (together with surgical procedure), resulting in 200 confirmed instances of lung most cancers (1.7%), of which 165 (82.5%) had been stage 0-I. Most instances had been lung adenocarcinomas.
The diagnostic efficiency of a single LDCT scan confirmed sensitivity 96.6% (200/207), specificity 82.2% (9,456/11,501), constructive predictive worth (PPV) 8.9% (200/2,245), detrimental predictive worth (NPV) 99.9% (9,456/9,463). Based mostly on NCCN and Chinese language skilled consensus standards, only one,883 (16.1%) and 4,902 (41.9%) individuals, respectively, had been labeled as “high-risk.”
Nevertheless, solely 38 (19.0%) and 112 (56.0%) of the confirmed lung most cancers instances met the respective high-risk definitions—similar to missed detection charges of 81.0% (162/200) and 44.0% (88/200). No vital distinction in lung most cancers detection charges was noticed between the NCCN-defined high-risk and non-high-risk teams (2.0% vs. 1.6%, P = 0.245).
In distinction, the Chinese language consensus definition yielded a considerably increased detection charge within the high-risk group (2.3% vs. 1.3%, P
Incorporating non-high-risk people into lung most cancers screening applications, based mostly on the distinctive epidemiological traits of lung most cancers in Chinese language populations, demonstrates for the primary time the worth of a non-risk-based technique in China. This strategy might provide a extra rational various to conventional risk-based screening by enabling the detection of a better variety of early-stage, doubtlessly curable lung cancers.
Future analysis ought to prioritize the identification of clinically vital lung most cancers subtypes warranting intervention to optimize affected person outcomes, in addition to the event of high-risk biomarkers or pre-screening enrichment methods tailor-made to populations not conventionally labeled as high-risk.
On the 2022 European Society for Medical Oncology (ESMO) Congress, Professors Jianxing He and Wenhua Liang’s staff offered the preliminary findings from the LUNG-CARE Venture as a Late-Breaking Summary (LBA48).
Key outcomes included the next: amongst people present process LDCT screening, 19.2% had clinically vital solitary nodules, and 1.7% had been pathologically confirmed to have lung most cancers. Notably, 86% of recognized lung cancers had been stage 0–I, phases typically related to healing potential.
Lung most cancers prevalence elevated progressively with age, peaking within the 60-64-year age group; nonetheless, the proportion of stage I cancers declined with advancing age, underscoring the significance of balancing detection charges and curability when designing screening applications.
Utilizing an unscreened cohort of roughly 110,000 residents from the identical group as a comparator, the LDCT screening cohort was related to a 63% discount in lung most cancers mortality (hazard ratio [HR]: 0.37), markedly decrease than the HR of 0.69 reported in China’s nationwide one-off screening initiative.
This enhanced survival profit could also be attributable to the inclusion of non-high-risk people within the LUNG-CARE Venture. Total, the screened cohort constantly exhibited superior prognostic outcomes in contrast with the unscreened cohort, possible resulting from the next proportion of early-stage most cancers detection.
Extra info:
Caichen Li et al, Non–Danger-Based mostly Lung Most cancers Screening With Low-Dose Computed Tomography, JAMA (2025). DOI: 10.1001/jama.2025.4017
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Nationwide Middle for Respiratory Medication
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Common screening strategy achieves a comparable detection charge of lung most cancers (2025, April 30)
retrieved 30 April 2025
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