Study shows feasibility, potential benefits of lung cancer screening for nonsmokers
Click Here to Manage Email Alerts
Key takeaways:
- Lung cancer screening for female Asian nonsmokers appeared feasible.
- Early results showed an invasive adenocarcinoma detection rate higher than that reported among smokers in the National Lung Screening Trial.
CHICAGO — A study that assessed the feasibility of lung cancer screening for certain nonsmokers yielded a higher invasive adenocarcinoma detection rate than the National Lung Screening Trial, which assessed screening for smokers who met key risk criteria.
The findings — presented at ASCO Annual Meeting — highlight the need for more emphasis on early detection of lung cancer among Asian female nonsmokers, investigators concluded.
“We acknowledge these are small numbers right now, but we hope this study is one step toward improving detection of lung cancer among people who never smoked,” researcher Elaine Shum, MD, oncologist at NYU Langone Health’s Perlmutter Cancer Center and assistant professor in the department of medicine at NYU Grossman School of Medicine, told Healio. “We also hope it will lead to larger studies that ultimately can help us change screening guidelines for nonsmokers.”
Background
Lung cancer is the most common cause of cancer death for Asian Americans, and the majority of cases are diagnosed in advanced stages.
The U.S. Preventive Services Task Force recommends annual lung cancer screening with low-dose CT for individuals aged 50 to 80 years and who have a 20 pack-year smoking history and either currently smoke or quit within the prior 15 years.
“Most people associate lung cancer with cigarette smoking. It is not as well known that lung cancer also unfortunately occurs among nonsmokers,” Shum said. “New York City has a relatively large Asian population, many of whom are nonsmokers. We were seeing many patients newly diagnosed with stage IV lung cancer. Our anecdotal experience, and our desire to do more for these patients, led us to design this pilot study.”
Shum and colleagues conducted the Female Asian Nonsmoker Screening Study (FANSS) to assess the feasibility of lung cancer screening with low-dose CT scans for this population in the United States.
The prospective, multicenter study includes women aged 40 to 74 years old who smoked fewer than 100 cigarettes in their lifetime and identify as being of Asian descent.
Researchers excluded women with a history of lung cancer and those who had undergone treatment for any other malignancy within the prior 5 years.
All women undergo a shared decision-making discussion prior to obtaining a baseline low-dose CT chest scan. A plasma-based assay developed by Delfi Diagnostics — designed to analyze cell-free DNA fragments for early detection of cancer — is also collected at the time of each scan.
Results
At data cutoff, 201 women (median age, 56.8 years; 41% reporting family history of lung cancer) underwent baseline low-dose CT scans at New York University.
The majority of women who completed baseline low-dose CT scans had Lung-RADS 1 (43%) or Lung-RADs 2 (50%) classification. Six (3%) had Lung-RADS 3 classification and seven (3.5%) had Lung-RADS 4 classification.
Five women with Lung-RADS 3 classification and three women with Lung-RADS 4 classification had solid, subsolid or ground-glass nodules larger than 6 mm that remained in close follow-up as of data cutoff.
Three women received diagnoses of invasive lung adenocarcinoma (stage IIB, n = 2; stage IIIC, n = 1).
This equated to a lung cancer detection rate of 1.5%. The National Lung Screening Trial — which served as the basis for initial lung cancer screening guidelines in the United States in 2013— yielded a lung cancer detection rate of 1.1%.
The TALENT study — which assessed lung cancer screening for high-risk nonsmokers in Taiwan — yielded an invasive adenocarcinoma detection rate of 1.52% and an overall lung cancer dictation rate of 2.6%.
All three women diagnosed with invasive lung adenocarcinoma in the FANSS study underwent surgical resection, were deemed to have EGFR mutation-positive tumors, and underwent adjuvant treatment with osimertinib (Tagrisso, AstraZeneca), an EGFR tyrosine kinase inhibitor.
Next steps and implications
Analysis of the plasma-based assay for cell-free DNA fragmentation is ongoing, according to investigators.
The FANSS study — which has a target enrollment of 1,000 women — is expanding to two other states, with participants planning to enroll at Massachusetts General Hospital Cancer Center and UC Irvine.
Shum and colleagues hope additional study in this area may eventually lead to lung cancer guidelines being updated to include nonsmokers.
“There are always a lot of questions — and some controversy — about lung cancer screening in this country, and we have to be prepared to answer those questions as we try to expand screening,” Shum told Healio. “However, our study and others show the population of nonsmokers with lung cancer is not small, and we have to do more for them. We also know the biology of lung cancer among nonsmokers is different from that of smokers, so there likely will be questions about the frequency of screening and when we do something about what we see on a scan.”
Collapse
Shum E, et al. Abstract 8510. Presented at: ASCO Annual Meeting; June 2-6, 2023; Chicago.
Click Here to Manage Email Alerts