Feasibility of implementing a national lung cancer screening program: Interim results from the Korean Lung Cancer Screening Project (K-LUCAS)

Jaeho Lee; Yeol Kim; Hyae Young Kim; Jin Mo Goo; Juntae Lim; Choon-Taek Lee; Seung Hun Jang; Won-Chul Lee; Chan Wha Lee; Kui Son Choi; Boyoung Park; Duk Hyoung Lee

doi:10.21037/tlcr-20-700

Feasibility of implementing a national lung cancer screening program: Interim results from the Korean Lung Cancer Screening Project (K-LUCAS)

Transl Lung Cancer Res. 2021 Feb;10(2):723-736. doi: 10.21037/tlcr-20-700.

Authors

Jaeho Lee¹, Yeol Kim^{1

2}, Hyae Young Kim³, Jin Mo Goo⁴, Juntae Lim^{1

2}, Choon-Taek Lee⁵, Seung Hun Jang⁶, Won-Chul Lee⁷, Chan Wha Lee³, Kui Son Choi^{1

2}, Boyoung Park^{1

2}, Duk Hyoung Lee¹

Affiliations

¹ National Cancer Control Institute, National Cancer Center, Goyang, Korea.
² Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
³ Department of Diagnostic Radiology, National Cancer Center, Goyang, Korea.
⁴ Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
⁵ Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
⁶ Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
⁷ Department of Preventive Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea.

Abstract

Background: Lung cancer screening conducted in high-risk group using low-dose computer tomography (LDCT) has been reported as an effective method to reduce lung cancer mortality in two large randomized-control trials. However, the effectiveness is uncertain when lung cancer screening is expanded to a nationwide population-based program.

Methods: The Korean Lung Cancer Screening Project (K-LUCAS) is a single-arm cohort study that was conducted from February 2017 to evaluate the feasibility of implementing an organized national lung cancer screening program in Korea. High-risk population aged 55-74 years with more than a 30-pack-year smoking history was recruited. Smoking history was obtained from administering questionnaires at national health screening programs or public smoking cessation programs which are already established programs in Korea. The screening results were reported using the Lung Imaging Reporting and Data System (Lung-RADS), suggested by the American College of Radiology. K-LUCAS was performed by a network-based diagnosis supporting system using a computer-aided detection (CAD) program to maintain screening quality. Current smokers were provided with mandatory smoking counseling.

Results: Among 71,829 participants aged 50 years or older in the national health screening program, 5,975 (8.3%) were eligible for lung cancer screening. Among them, 1,062 (17.8%) refused to participate in K-LUCAS. Additionally, 779 participants were recruited in the smoking cessation program. Thus, a total of 5,692 eligible high-risk participants were recruited in this study. Among them, 865 (15.2%) had positive screening results, which requires a further examination; 529 (9.3%) had Lung-RADS category 3 (indeterminate), and 336 (5.9%) had category 4 (suspicious of lung cancer); 42 (0.7%) had confirmed lung cancer. Approximately 66.7% had early-stage lung cancer: 24 (57.1%), stage I and 4 (9.5%), stage II. Six (1.1%) patients developed complications at the time of diagnosis, including one death. The anxiety level related to cancer screening was low. Participation in screening encouraged motivation to quit smoking.

Conclusions: K-LUCAS provided promising evidence supporting the implementation of a national lung cancer screening program to detect early stage lung cancer and promote smoking cessation for participants in Asian population.

Keywords: Lung cancer; low-dose computer tomography (LDCT); screening; smokers.