Role of Low-Dose Computerized Tomography in Lung Cancer Screening among Never-Smokers

• Published in: Journal of thoracic oncology 2019-03, Vol.14 (3), p.436-444
• Main Authors: Kang, Hye-Rin, Cho, Jun Yeun, Lee, Sang Hoon, Lee, Yeon Joo, Park, Jong Sun, Cho, Young-Jae, Yoon, Ho Il, Lee, Kyung Won, Lee, Jae Ho, Lee, Choon-Taek
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Adenocarcinoma of Lung - diagnosis; Adenocarcinoma of Lung - diagnostic imaging; Adenocarcinoma of Lung - epidemiology; Adult; Aged; Carcinoma, Large Cell - diagnosis; Carcinoma, Large Cell - diagnostic imaging; Carcinoma, Large Cell - epidemiology; Carcinoma, Non-Small-Cell Lung - diagnosis; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - epidemiology; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - epidemiology; Early Detection of Cancer - methods; Female; Follow-Up Studies; Humans; Incidence; Low-dose chest computerized tomography; Lung cancer; Lung Neoplasms - diagnosis; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - epidemiology; Male; Middle Aged; Never-smoker; Prognosis; Radiation Dosage; Retrospective Studies; Risk Factors; Small Cell Lung Carcinoma - diagnosis; Small Cell Lung Carcinoma - diagnostic imaging; Small Cell Lung Carcinoma - epidemiology; Smoking - epidemiology; Survival Rate; Tomography, X-Ray Computed - methods
• ISSN: 1556-0864; 1556-1380
• DOI: 10.1016/j.jtho.2018.11.002

The incidence of lung cancer among never-smokers has been increasing rapidly. The U. S. National Lung Screening Trial and the NELSON trial showed that screening using low-dose computerized tomography (LDCT) effectively reduced lung cancer mortality among heavy smokers. However, its effectiveness in never-smokers has not been well investigated. This study investigated the role of LDCT in lung cancer screening among never-smokers. The study was designed as a single-center, retrospective cohort study. We analyzed the data on patients who underwent LDCT screening between May 2003 and June 2016. Nodules detected by computerized tomography were classified according to the Lung Imaging Reporting and Data System criteria. The detection rate and lung cancer outcomes (type of cancer, staging of lung cancer, and mortality) according to smoking history were determined. Of the 28,807 enrolled patients, 12,176 were never-smokers; of these patients, 7744 (63.6%) were women and 1218 (10.0%) were found to have lung nodules. Overall, lung cancer was diagnosed in 55 never-smokers (0.45%). In contrast, lung cancer was diagnosed in 143 (0.86%) of the 16,631 ever-smokers. Of the never-smokers with lung cancer, 51 (92.7%) presented with stage I disease, and all patients had adenocarcinomas. In the never-smoker population, LDCT screening helped to detect a significant number of lung cancers. Most of these lung cancers were detected at a very early stage. The positive results of the National Lung Screening Trial in the United States and the NELSON trial may have established the value of LDCT screening for heavy smokers, but future research should consider the value of using LDCT screening in the never-smoker population.