Insights Into Opportunistic Lung Cancer Screening for Individuals Who Have Never Smoked
Mené en Corée du Sud à partir de données portant sur 21 062 personnes n'ayant jamais fumé et participant à un programme de dépistage du cancer du poumon par tomographie numérique à faible dose de rayonnement (âge moyen : 59,8 ans ; 76,6 % de femmes ; durée moyenne de suivi : 83,8 mois), cette étude multicentrique évalue, en fonction du sexe, le nombre de décès par cancer du poumon et les taux de survie spécifique à 5 ans
Lung cancer remains the deadliest malignant neoplasm globally; and due to a combination of its high overall incidence and falling tobacco smoking rates, lung cancer among individuals who have never smoked (LCINS) now represents the seventh most common cancer and fifth leading cause of cancer-related deaths globally. Female sex, Asian ancestry, and family history of lung cancer are among the most frequently cited risk factors for LCINS, which overwhelmingly presents with adenocarcinoma histology, making it pathologically distinct from smoking-related lung cancer. As both the National Lung Screening Trial (NLST) and the Dutch-Belgian Randomized Lung Cancer Screening Trial demonstrated that lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality among individuals with a substantial smoking history, there has been considerable interest in evaluating LDCT for LCS among individuals who have never smoked (INS). To date, several high-profile, nonrandomized observational studies out of Asia have demonstrated the ability of LCS with LDCT to detect LCINS. However, the question of whether screen-detected LCINS predominantly represents early-stage lethal disease vs indolent nonlethal disease (ie, overdiagnosis) remains unanswered and an ongoing subject of debate.
JAMA Network Open , éditorial en libre accès, 2024