Lung Cancer Screening in Asia: An Expert Consensus Report.

The incidence and mortality of lung cancer are highest in Asia compared to Europe and USA, with the incidence and mortality rates being 34.4 and 28.1 per 100,000 respectively in East Asia. Diagnosing lung cancer at early stages makes the disease amenable to curative treatment and reduces mortality. In some areas in Asia, limited availability of robust diagnostic tools and treatment modalities, along with variations in specific healthcare investment and policies, make it necessary to have a more specific approach for screening, early detection, diagnosis, and treatment of lung cancer patients in Asia compared to the West. A group of 19 advisors across different specialties from 11 Asian countries, met on a virtual Steering Committee meeting, to discuss and recommend the most affordable and accessible lung cancer screening modalities and their implementation, for the Asian population. Significant risk factors identified for lung cancer in smokers in Asia include age 50-75 years and smoking history of >20 pack-years. Family history is the most common risk factor for non-smokers. Low-dose computed tomography (LDCT) screening is recommended once a year for patients with screening-detected abnormality and persistent exposure to risk factors. However, for high-risk heavy smokers and non-smokers with risk factors, reassessment scans are recommended at an initial interval of 6 to 12 months with subsequent lengthening of reassessment intervals, and it should be stopped in patients > 80 years of age or are unable or unwilling to undergo curative treatment. Asian countries face several challenges in implementing LDCT screening, such as economic limitations, lack of efforts for early detection, and lack of specific government programs. Various strategies are suggested to overcome these challenges in Asia.