Lung Cancer Risk High in Never-Smokers With Positive Family History: Lancet

The Taiwan Lung Cancer Screening in Never-Smoker Trial (TALENT) has revealed compelling insights into the prevalence and risk factors of lung cancer among non-smokers. The findings were published in the Lancet Respiratory Medicine.

The study was conducted across 17 medical centers in Taiwan and primarily focused on individuals aged 55 to 75 years who never smoked or had minimal smoking history along with additional risk factors for lung cancer. Lung cancers in Taiwan are disproportionately affecting never-smokers with nearly 60% diagnosed at a very advanced stage.

The study spanned over 8 years and included 12,011 participants, of which 6009 had a family history of lung cancer. LDCT scans at baseline identified 17.4% as positive, leading to the diagnosis of lung cancer in 2.6% of participants. Also, 77.4% of diagnosed cases were at stage I which highlighted the potential impact of early detection.

Participants with a family history of lung cancer demonstrated a higher prevalence of invasive lung cancer with increasing age. Factors such as female sex and age over 60 correlated with an increased risk of lung cancer. Importantly, passive smoke exposure and cooking-related variables showed no significant associations with lung cancer. The LDCT screening exhibited a high sensitivity of 92.1% and specificity of 84.6% that emphasize its effectiveness in early detection.

This study also acknowledges the potential for overdiagnosis, specially in cases of adenocarcinoma in situ. Further investigations into risk factors for lung cancer in non-smokers, especially those without a family history will be important to refine the screening protocols and improving outcomes in this vulnerable population. 

Reference:

Chang, G.-C., Chiu, C.-H., Yu, C.-J., Chang, Y.-C., Chang, Y.-H., Hsu, K.-H., Wu, Y.-C., Chen, C.-Y., Hsu, H.-H., Wu, M.-T., Yang, C.-T., Chong, I.-W., Lin, Y.-C., Hsia, T.-C., Lin, M.-C., Su, W.-C., Lin, C.-B., Lee, K.-Y., Wei, Y.-F., … Yang, S.-C. (2023). Low-dose CT screening among never-smokers with or without a family history of lung cancer in Taiwan: a prospective cohort study. In The Lancet Respiratory Medicine. Elsevier BV. https://doi.org/10.1016/s2213-2600(23)00338-7