medwireNews: The Taiwan Lung Cancer Screening in Never-Smoker Trial (TALENT) suggests that low-dose computed tomography (CT) screening may help to detect early-stage disease in never smokers at high risk for developing lung cancer.
Presenting the findings at the IASLC 2020 World Conference on Lung Cancer, Pan-Chyr Yang (National Taiwan University, Taipei) explained that lung cancer incidence in never smokers is rising, especially in East Asia, and recent research has suggested that the disease in this population has a distinct genomic profile and pattern of carcinogenesis and progression.
As low-dose CT screening in heavy smokers has been associated with reduced lung cancer mortality, the TALENT investigators sought to examine the effect in never smokers with one high-risk feature, namely:
- family history of lung cancer;
- environmental exposure to tobacco smoke;
- chronic lung disease (such as tuberculosis or chronic obstructive pulmonary disease);
- cooking index ≥110 (based on the frequency of using pan-, stir-, or deep-frying methods); or
- cooking without using ventilation.
The trial included 12,011 individuals aged 55–75 years who had either never smoked or were a light ex-smoker (smoking index <10 pack–years and quit >15 years ago) and who received a chest X-ray at one of 17 medical centers between February 2015 and July 2019. Those with suspicious findings underwent standard-dose chest CT, while those with negative findings received a low-dose CT scan, had blood and urine assessments, and completed a health questionnaire.
In all, lung cancer was detected in 2.6% of participants, with invasive disease in 2.1%, reported Yang, noting that the overall detection rate was higher than the 1.1% and 0.9% rates observed in the National Lung Screening Trial (NLST) and NELSON study, respectively, both of which recruited heavy smokers.
The majority (96.5%) of detected cancers were of stage 0–IB, with stage IIB disease detected in three individuals, stage IIIA in two, stage IIIB in one, and stage IV in five people.
Yang highlighted that the detection rate was significantly higher among the 50% of participants with a family history of lung cancer versus those without, at 3.2% versus 2.0%, and a relative risk (RR) of 1.61.
The RR rose to a significant 1.69 when a first-degree family member was affected, with significant RRs of 2.00, 1.78, and 1.43 for a brother, sister, or mother, respectively, but the risk did not appear to be increased for individuals whose father had lung cancer.
The number of affected family members was also important, with the rate of detected lung cancers rising from 3.1% among those with one affected family member to 9.1% among those with four or more, while the corresponding rates were 2.5% and 9.1% when just family members with invasive disease were considered.
No other risk factor, such as environmental tobacco exposure or cooking without ventilation, was associated with a significantly increased risk for lung cancer diagnosis, said the presenter.
Discussing the presentation, Ugo Pastorino (Istituto Nazionale dei Tumori, Milan, Italy) said that although follow-up and mortality data were not presented, TALENT “provides new evidence on lung cancer risks,” and could lead to modifications in low-dose CT screening eligibility in Asia.
He added, however, that more research is needed on the biology of lung cancer in nonsmokers.
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IASLC 2020 World Conference on Lung Cancer; 28–31 January 2021