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PS01.02 National Lung Cancer Screening Program in Taiwan: The TALENT Study

      Introduction

      Lung cancer in never-smoker is a global rising threat especially in East Asia. Our recent proteogenomics study has revealed the demographically distinct signatures of oncogenesis and progression of this dreadful disease and provide new insights into the precision management of early lung cancer. Currently, early detection is the most effective way to improve lung cancer survival. Low-dose computed tomography (LDCT) has been proven effective for lung cancer screening. However, most of the lung cancer screenings focused on heavy smoker which may not be suitable for East Asian population. In Taiwan, lung cancer is the leading cause of cancer mortality and 53% were never-smoker. We therefore conducted a nationwide lung cancer LDCT screening focused on never-smoker (TALENT: Taiwan Lung Cancer Screening for Never Smoker Trial) aiming to develop an effective strategy for screening of lung cancer in never-smoker and establish a risk prediction model to identify high-risk population that may benefit from LDCT screening. Here we report on behalf of the TALENT study group the first round (T0) results.

      Methods

      This is a prospective, multicenter study sponsored by The Ministry of Health and Welfare, Taiwan. The inclusion criteria were age between 55-75 years, never-smoker and having one of the following risks: family history of lung cancer within third-degree, passive smoking exposure, TB/COPD, cooking index ≥ 110, and not using ventilator during cooking. The LDCT was conducted according to the guideline suggested by ACR. A solid or part-solid (PS) nodule larger than 6 mm or pure ground glass nodule (GGN) larger than 5 mm in diameter was designated as positive on LDCT. The PBMC DNA was obtained for SNP typing analysis. Institutional Review Board approved the study and informed consent was obtained from each participating subject.

      Results

      From Feb. 2015 to July 2019, a total of 12,011 subjects (Table 1) were enrolled. Among them, 6,012 (50.1%) had lung cancer family history, 5,999 (49.9%) did not. In 12,011 scans, 2,094 (17.4%) were considered positive, there were 392 subjects (3.3%) underwent lung biopsies or surgeries at T0, lung cancer (2.6%) were diagnosed in 311 subjects, 254 (2.1%) were invasive lung cancer. All but one was adenocarcinoma and 96.5% were stage 0 or I, 81 had benign lung disease or malignancy other than primary lung cancer. The prevalence of lung cancer was 3.2% and 2.0% in subjects with and without lung cancer family history, respectively. The prevalence of invasive lung cancer was 2.6% and 1.6%, respectively. For subjects with lung cancer family history, the prevalence of lung cancer was 3.3%, 1.6% and 1.7% in those with 1st degree, 2nd degree and 3rd degree families had lung cancer, respectively.
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      Conclusion

      The TALENT study confirmed the effectiveness of LDCT screening in a pre-defined, never-smoker high-risk population. The T0 lung cancer detection rate was 2.6%, which was even higher than NLST study (1.1%) and NELSON study (0.9%). Most importantly, 96.5% patients were stage 0 or 1, that were potentially curable by surgery. Our study also revealed the high risk of family history, especially those subjects with 1st degree families had lung cancer.

      Keywords

      LDCT screening, never-smoker, lung cancer