Newly published expert consensus recommends urgent shift to low-dose CT screening to detect lung cancer earlier

• Lung cancer is one of the leading causes of death and disease in India, ranking second in the world.
• Improved access to lung cancer screening critical to saving lives in India and across Asia.

As per a new consensus by 19 experts across Asia, published in the Journal of Thoracic Oncology, it has been found that the use of a low dose computed tomography (LDCT) scan can significantly reduce the number of deaths caused due to lung cancer. Asia bears the greatest burden from the world’s most common form of lung cancer, and experts note that deaths caused by the disease could be reduced by ensuring earlier diagnosis through improved screening access and changes to how people are screened.¹

Among their recommendations, which were shared at the World Conference on Lung Cancer being held in Singapore this week, experts urge a shift from traditionally used chest X-rays to a more advanced procedure known as LDCT,¹ which uses a computer with low dose X-rays to generate a series of pictures and can help to detect lung abnormalities, including tumours.² 

Lung cancer is the fourth most common cancer and among the top 5 cancers leading to death in India. Each year, over 72,000 cases are diagnosed in India alone. In a proof-of-concept pilot study in smokers conducted at a tertiary centre, lung nodules were found in 335 (93%) smokers.³ Lung cancer accounts for 5.9% of all incidences of cancer and 8.1% of all cancer-related deaths.⁴

The consensus is the result of extensive discussion among experts from Hong Kong, India, Indonesia, Japan, Malaysia, the Philippines, Singapore, South Korea, Taiwan, Thailand, Vietnam, backed by the Lung Ambition Alliance (LAA), a non-profit collaboration between the International Association for the Study of Lung Cancer (IASLC), the Global Lung Cancer Coalition (GLCC), AstraZeneca, and Guardant Health. The experts also called for improvements to the incorporation of smoking cessation programmes alongside lung cancer screening programmes.¹

In most parts of Asia, LDCT is still not implemented in routine lung cancer screening programs due to challenges such as perceived cost, reimbursement, lack of infrastructure and trained staff, reluctance of eligible high-risk individuals, as well as absence of well-defined guidelines.^1 ‘

Dr. Anil Kukreja, Vice President, Medical Regulatory Affair, said “Empowering lives and defeating lung cancer in India hinges on one crucial element which is early detection. The implementation of risk prediction models and AI-supportive modalities to boost the efficacy of screening and follow-up with LDCT was another recommendation by the experts to overcome the lack of access challenges. In India, implementing LDCT is a challenge, but we are leveraging AI for screening, and it can be a modality which will help in early diagnosis.

Currently with our partners like Qure.ai, we are improving access and their technology is already implemented in few states. By enhancing access to lung screening programs and establishing standardized protocols, we stand resolute in the fight against lung cancer, leaving a profound and lasting impact on integrated lung healthcare. At AstraZeneca, we are always working towards saving more lives from lung cancer through timely intervention.”

Artificial intelligence (AI) based algorithms have demonstrated increased accuracy in predicting the risk of Lung Cancer among patients with an incidental pulmonary nodule on chest radiographs.⁵ Qure.ai, a leading artificial intelligence solutions provider for imaging technologies, has deployed AI-enabled chest imaging solutions that can detect nodules and flag the malignancy risk of the nodule using their proprietary lung nodule malignancy score (LNMS) based on the nodule characteristics.

Prashant Warier, Co-founder and CEO of Qure.ai opined, “We are looking forward to seeing more such discourses shaping up new paradigms of clinical care when it comes to defeating lung cancer. By harnessing the power of AI and advanced imaging, we aim to transform how incidental pulmonary nodules are identified and categorized, enabling clinicians to discern high or low risk of lung cancer swiftly.”

At Qure.ai, we are committed to redefining healthcare paradigms and enhancing patient outcomes through cutting-edge AI solutions. Our partnership with AstraZeneca is a perfect example of creating such real impact,” he added.

According to the consensus, patients with detected screening abnormalities while undergoing routine health screening and persistent exposure to risk factors are recommended to be screened with LDCT annually, while high-risk heavy smokers should do so twice a year.¹

While smoking is the leading risk factor, lung cancer among never-smokers accounts for a substantial proportion of cases.⁶ Studies have shown a higher proportion of non-smoking lung cancer patients in Asia, when compared to Europe and North America.^7-10 In addition, non-smoking lung cancer patients in Asia are more likely to be diagnosed at an earlier age compared with current and former smokers^9,11. India has over 10 crore adult smokers, ranking second in the world.

Therefore, the experts agree that it is necessary to support high-risk patients to access screening procedures, irrespective of their smoking status, by considering factors such as genetics and demographics.

Although the lung cancer death rate has been steady or decreasing in Western countries,¹² it has been increasing in Asia for the past two decades.¹³ Experts believe the high cancer death rate in low-and middle-income Asian countries can be attributed to several factors, including patients not always being able to access the right treatment for them.¹⁴  Documenting country-specific evidence on risk factors among never-smokers, which include age, family history of lung cancer, history of other cancers, second-hand smoking, and exposure to indoor (cooking and heating fumes) and outdoor air pollution, could also help garner government support in establishing a lung cancer screening program locally, they note.

To overcome these difficulties, the experts recommend improving access to lung screening programmes and subsequent care by having a standardised protocol for follow-up LDCT scans and consideration for integrated lung healthcare, such as a national screening programme.