Never-smoker lung cancer survivors require targeted surveillance
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Never-smoker lung cancer survivors face a similar risk for second primary lung cancers as those who have ever smoked, according to study results published in JAMA Network Open.
“This study’s findings highlight the need to identify optimal surveillance strategies for second primary lung cancers among long-term, never-smoking survivors,” investigator Summer S. Han, PhD, associate professor in the Quantitative Sciences Unit within the department of neurosurgery at Stanford University School of Medicine, told Healio.
Han and colleagues conducted a cohort study of 211,414 participants to estimate and compare cumulative second primary lung cancer (SPLC) incidence among lung caner survivors who ever smoked vs. those who never smoked.
Results showed a sevenfold increase in cumulative 10-year incidence of initial primary lung cancer among ever-smokers vs. never-smokers; however, risk for SPLC appeared comparable regardless of smoking history.
Healio spoke with Han about the findings and their implications.
Healio: Why did you conduct this study?
Han: Lung cancer among never-smokers accounts for 25% of all lung cancers in the U.S. Recent therapeutic advances have improved survival among patients with initial primary lung cancer, who are now at high risk for developing SPLC. As smoking rates continue to decline in the U.S., it is critical to examine more closely the epidemiology of lung cancer among patients who never smoked, including their risk for SPLC.
Healio: What did you find?
Han: The incidence of SPLC is as high among lung cancer survivors who never smoked as it is among those who have ever smoked. This study looked at large, diverse population-level data with long-term follow-up to determine the incidence of SPLC in different groups. Although the incidence of initial primary lung cancer in the general population was seven times higher for current and former smokers compared with never-smokers, the incidence of SPLC following an initial primary lung cancer diagnosis was as high among those who ever smoked (2.84%) as those who never smoked (2.72%).
Healio: Did this finding surprise you?
Han: Given the sevenfold lower incidence of initial primary lung cancer among never-smokers compared with ever-smokers, we were surprised that SPLC risk was as high — even slightly higher — among never-smokers as patients who have ever smoked.
Although the reasons behind this observation are still poorly understood, prior studies showed never-smokers survive longer after initial primary lung cancer. The longer survival may translate to even longer time at risk for SPLC, thus requiring long-term follow-up. Our findings highlight the critical need to identify risk factors for SPLC among never-smokers and to develop a targeted surveillance strategy for this population.
Healio: How might surveillance for this population be optimized?
Han: Current ASCO and National Comprehensive Cancer Network guidelines recommend low-dose CT scans annually 2 to 3 years after curative treatment for surveillance of secondary malignancies. However, the optimal screening strategy is unclear beyond 5 years since initial primary lung cancer diagnosis.
Notably, SPLC exhibits a sustained risk for more than 10 years. This study's findings highlight the need to identify optimal surveillance strategies for SPLC among long-term, never-smoking survivors.
Because randomized clinical trials are unlikely in this setting, where stopping screening or screening less than annually may result in potential harm, alternative novel methods — such as trial emulation and simulation studies that leverage large health care utilization and outcomes data sets — may be critical next steps to fill the evidence gap.
For more information :
Summer S. Han, PhD, can be reached at Stanford University School of Medicine, 3180 Porter Drive, Office 118, Stanford, CA 94304; email: summerh@stanford.edu.
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