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Pre-screening mechanism for LDCT lung cancer screening: Identifying higher-risk individuals among never smokers

机译：LDCT肺癌筛查的预筛查机制：确定从未吸烟者中的高危人群

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Objective:There has been an alarming increase of lung cancer, 3.4-fold at age 65-69 rate and 13-fold in total number in 35 years, among nonsmoking women in Taiwan, The worried well, concerned with their risk, demanded LDCT screening. However, current recommendation was limited to heavy smokers with 30 pack years. Screening low-risk individuals had the potential of causing substantial harms.Methods:A cohort of 439,119 adults, who had complete medical work up during health surveillance program, between 1994 and 2008, had their IDs matched for lung cancer with National Cancer Registry. Higher lung cancer risk nonsmokers could be identified with prediction models.Results:Significant risks were found among nonsmokers as follows: Personal history of any cancer or family history of lung cancer; body weight, Reduced spirometry such as FEV1; biomarkers, including elevated Alfa-feto-protean(AFP), Carcino-Embronic Antigen(CEA), and C-reactive Protean (CRP), low bilirubin, second hand smoking, abnormal chest X-ray and geo-coded PM2.5 for air pollution. With 1,307 incidence lung cancer, including nonsmokers (607), light smokers (274) and heavy smokers (426), a prediction model was developed, with ROC 0.806-0.847. A simple 5-year risk score was established for nonsmokers and light smokers to check their risk before LDCT.Conclusions:With risk-data available, a small portion of nonsmokers (3%) and one fifth of light smokers (20%) could be found qualified for LDCT screening, as they reached 5-year lung cancer risk of heavy smokers, 1.5% in 5 years. This pre-screening model could save unnecessary LDCT procedures and avoid harms and cost associated with screening low risk individuals.
机译：目的：台湾非吸烟女性中肺癌的发生率令人震惊，在65-69岁年龄段中是3.4倍，在35年中总数是13倍。担心的同时，担心其风险，要求进行LDCT筛查。但是，当前的建议仅限于30年包烟的重度吸烟者。方法：1994年至2008年间，在健康监测计划期间完成医学工作的439,119名成年人的队列研究使他们的ID与肺癌相匹配的国家癌症登记处。结果：在非吸烟者中发现了以下重大风险：个人癌症史或肺癌家族史;体重，肺活量减少，例如FEV1;生物标志物，包括高水平的阿尔法-胎蛋白（AFP），癌蛋白-胚胎抗原（CEA）和C反应蛋白（CRP），低胆红素，二手烟，异常X线胸片和地理编码的PM2.5空气污染。以包括非吸烟者（607），轻度吸烟者（274）和重度吸烟者（426）在内的1,307例肺癌发病率为基础，建立了ROC 0.806-0.847的预测模型。为不吸烟者和轻度吸烟者建立了一个简单的5年风险评分，以在LDCT前检查其风险。结论：有了风险数据，一小部分不吸烟者（3％）和五分之一的轻度吸烟者（20％）被发现有资格进行LDCT筛查，因为他们达到5年重度吸烟者患肺癌的风险，在5年内达到1.5％。这种预筛选模型可以节省不必要的LDCT程序，并避免与筛选低风险个体相关的伤害和成本。

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