New Delhi: A recent consensus reached by a group of 19 experts from Asia, published in the Journal of Thoracic Oncology, it has been determined that the utilisation of low-dose computed tomography (LDCT) scans can significantly diminish the number of fatalities attributed to lung cancer.
Asia carries the greatest burden of the most prevalent form of lung cancer globally, and these experts emphasise that fatalities stemming from the disease could be reduced by facilitating earlier detection through enhanced access to screening and modifications to screening methodologies. These recommendations were presented at the World Conference on Lung Cancer, held in Singapore during the current week.
Among the suggestions presented at the conference, these experts strongly advocate transitioning from the conventional use of chest X-rays to the more advanced LDCT procedure. LDCT employs low-dose X-rays through computer technology to generate a series of images capable of identifying lung abnormalities, including tumors.
Lung cancer ranks as the fourth most frequently occurring cancer and is one of the top five causes of death in India. Annually, India alone witnesses over 72,000 new cases diagnosed. In a preliminary pilot study conducted at a tertiary medical facility involving smokers, lung nodules were detected in 93 per cent of the participants. Lung cancer accounts for 5.9 per cent of all cancer incidences and 8.1 per cent of all cancer-related fatalities.
This consensus was the result of extensive deliberations among experts hailing from Hong Kong, India, Indonesia, Japan, Malaysia, the Philippines, Singapore, South Korea, Taiwan, Thailand, and 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. Furthermore, these experts called for enhancements in the integration of smoking cessation programs alongside lung cancer screening initiatives.
In most regions of Asia, the routine inclusion of LDCT in lung cancer screening programs is still not widespread due to challenges such as perceived costs, reimbursement issues, inadequate infrastructure and trained personnel, hesitance among eligible high-risk individuals, and the absence of well-defined guidelines.
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.”
In the realm of medical imaging, AI-driven algorithms have showcased improved precision when it comes to forecasting the likelihood of Lung Cancer in individuals who happen to have an unexpected pulmonary nodule appear on their chest X-rays. Qure.ai, a prominent provider of artificial intelligence solutions in the field of imaging technology, has implemented AI-enhanced solutions for chest imaging. These solutions are capable of identifying nodules and indicating the potential malignancy risk associated with the nodule by utilising their unique lung nodule malignancy score (LNMS), which relies on the characteristics of the nodule.
“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 categorised, enabling clinicians to discern high or low risk of lung cancer swiftly,” saidPrashant Warier, Co-founder and CEO, Qure.ai.
In line with the prevailing consensus, individuals who exhibit screening abnormalities during their routine health check-ups and have continuous exposure to risk factors are advised to undergo annual LDCT screening. High-risk heavy smokers, on the other hand, are recommended to have biannual screenings. It’s worth noting that while smoking remains the primary risk factor, a significant number of lung cancer cases occur among non-smokers. Studies have revealed a higher prevalence of non-smoking lung cancer patients in Asia compared to Europe and North America, and these Asian patients tend to be diagnosed at a younger age than their smoking counterparts.
India, with over 10 crore adult smokers, ranks as the world’s second-largest smoking population. Therefore, experts concur that supporting high-risk individuals in accessing screening procedures is imperative, regardless of their smoking history, with consideration for genetic and demographic factors.
While the lung cancer mortality rate has remained stable or declined in Western countries, it has been on the rise in Asia for the past two decades. Experts attribute this increase to various factors, including limited access to appropriate treatment for patients in low- and middle-income Asian nations. To address these challenges, experts propose enhancing access to lung screening programs and subsequent care through the establishment of a standardized protocol for follow-up LDCT scans and the incorporation of comprehensive lung healthcare into national screening initiatives.
Moreover, experts suggest that documenting country-specific evidence regarding risk factors among non-smokers, including age, family history of lung cancer, prior history of other cancers, exposure to second-hand smoke, indoor air pollution (from cooking and heating), and outdoor air pollution, could help garner governmental support for local lung cancer screening programs.