Assessment of Selection Criteria for Low-dose Lung Screening CT among Asian Ethnic Groups in Taiwan - From mass screening to specific risk-based screening for non-smoker lung cancer

Structured abstract Background The National Lung Screening Trial (NLST) showed low-dose screening chest CT reduced lung cancer mortality rate up to 20% in high risk patients in the United States. We aim to investigate the impact of applying the NLST eligibility criteria to the population in Taiwan, and to identify additional risk factors to select subjects at risk of lung cancer. Patients and Methods We retrospectively review the medical record of 1763 asymptomatic healthy subjects (40∼80 year old) who voluntarily underwent low-dose chest CT (1029 male, 734 female) from August 2013 to August 2014. Clinical information and nodule characteristics were recorded. Results of subsequent follow-up and outcome were also recorded. Results 8.4% (148/1763) of subjects would have been eligible for lung cancer screening based on the NLST criteria. However, only one of these eligible subjects would have a lung cancer detected at baseline. Among the 1615 subjects who did not meet the NLST criteria, the detection rates of lung cancer was 2.6% in women and 0.56% in men. Logistic regression showed that female gender and a family history of lung cancer were the two most important predictor of lung cancer in Taiwan (odds ratio of 6.367, P value = 0.003; odds ratio of 3.017, P value = 0.016, respectively). Conclusions In conclusion, NLST eligibility criteria may not be effective in screening lung cancer in Taiwan. Risk-based prediction model based on the family history of lung cancer and female gender can potentially improve efficiency of lung cancer screening programs in Taiwan.