ASCO 2023: New Advances in Lung Cancer Screening

By Heather Law, MA, Associate Director, GO2’s Lung Cancer Registry 

Lung cancer screening is unavailable for many people at risk for lung cancer. At the 2023 American Society of Clinical Oncology (ASCO) meeting, early results from groundbreaking studies offered hope for expanded screening in the United States.  

Current screening criteria in the United States

The U.S. Preventive Services Task Force (USPSTF) currently recommends lung cancer screening for people who meet these criteria:  

Adults aged 50 to 80 years old who have a 20 pack-year smoking history* and currently smoke or have quit within the past 15 years. 

*Pack year history = # of packs smoked per day multiplied by # of years smoking. For example: 1 pack per day X 20 years = 20 pack years. 

For people who meet these criteria, USPSTF recommends: 

• Screening for lung cancer with low-dose computed tomography (LDCT) every year 
• Ending annual screening once a person has not smoked for 15 years or has a health problem that limits life expectancy or the ability to have lung surgery 

Unfortunately, it is estimated that only 6% of those who meet the USPSTF criteria are screened. Also, there are people who do not meet these criteria but are at risk for lung cancer and would benefit from screening. 

Expanding eligibility criteria for lung cancer screening 

Presentations at ASCO highlighted the importance of looking at non-smoking related risk factors for lung cancer such as family history, chronic lung disease, air pollution, and exposure to carcinogens (substances that can cause cancer) from cooking. 

Researchers from the National Taiwan University Hospital highlighted that Asia has the highest burden of lung cancer in the world, representing 60% of new cases. Asia also has the highest mortality rate for both males and females. Furthermore, 30-40% of people with lung cancer in East Asia do not have a smoking history.  

The Taiwan Lung Cancer Screening in Never Smoker Trial (TALENT) study, which was conducted from 2015-2019, screened male and female never smokers using LDCT. To be eligible, participants also needed to meet at least one of the following criteria:  

• Family history of lung cancer 
• Second-hand smoke exposure 
• Chronic lung disease (TB, COPD) 
• Cooking with poor or no ventilation 

The TALENT study had a good detection rate that supported the launch of a nation-wide biannual (twice per year) LDCT lung cancer screening program for the people who: 

• Have a smoking history
  Adults aged 50-74 years old who have a 30 pack-year smoking history and agree to quit smoking or have quit within the past 15 years 
• Do not have a smoking history but have a family history of lung cancer
  Females aged 45-74 years old and males aged 50-74 years old 

Based on early results, the lung cancer detection rate is significantly higher for female Asian never smokers. These findings are consistent with other studies that show that in Asia approximately 60-80% of women with lung cancer never smoked, suggesting other factors, beyond smoking, contribute to their risk. 

The Female Asian Nonsmoker Screening Study (FANSS) based at NYU is an ongoing study designed to assess the feasibility of lung cancer screening in Asian women without a smoking history. The large NIH-funded study involves screening female Asian never smokers aged 40-74 years old who live in New York City. Unlike the TALENT study in Taiwan that only used LDCT, the FANSS study uses both LDCT as well as a blood based screening test from Delfi Diagnostics. The Delfi test uses computers to analyze DNA in blood for signs of cancer. The FANNS study is also looking at air pollution as a lung cancer risk factor by studying World Trade Center dust exposure from 9/11. Based on initial findings, the FANSS study had a similar detection rate to the TALENT study in Taiwan. 

A new frontier for lung cancer screening  

The Delfi test currently being used in the FANSS study is just one of many blood-based early cancer detection tests being developed and studied. For instance, GRAIL Galleri is a multi-cancer early detection test that is currently being used as part of a large trial sponsored by the National Health Service in England that hopes to enroll 1.5 million people. It has currently enrolled 140,000.  

Expanding lung cancer screening to people without a smoking history needs further exploration in the U.S., including conversations with policy makers and insurers. The long-term goal is to understand other risk factors, screen more people at risk, and save lives.