ldct screening :: Article CreatorHow A Cheek Swab Could Help Fight Lung Cancer
Though further studies and large-scale clinical trials are needed to optimize and advance the technology toward translation into clinical care, Backman is optimistic about this method's potential impact on lung cancer care and other cancers.
"The field carcinogenesis/chromatin alteration detection paradigm has the potential to be applied to other major cancers including colon, ovarian, esophagus, prostate, breast, and others, offering hope for reductions in mortality similar to what was seen after the introduction of the Pap smear for cervical cancer (around 90 percent, in that case)," Backman said.
Backman is the Sachs Family Professor of Biomedical Engineering and Medicine at the McCormick School of Engineering. He directs the CPGE, which focuses on studying and manipulating chromatin structure, which regulates gene expression, to treat disease and engineer living systems to overcome environmental challenges. This work builds on previous research by the CPGE, such as the modeling of chromatin structure, identification of early genomic alterations in carcinogenesis, and the application of artificial intelligence to improve the diagnostic performance of the technology.
The current industry standard for lung cancer screening is low-dose computed tomography (LDCT). However, cost, access, stigma, and lack of adherence to LDCT guidelines are among the major challenges limiting its impact, as only about five percent of the LDCT-eligible population undergoes screening, resulting in most lung cancer cases being detected at an advanced stage. Other testing methods such as chest X-rays and sputum cytology have proven unsatisfactory when evaluated in large-scale clinical screening settings.
In the big picture, this is a radically new approach to cancer screening and early detection with implications for a range of other major cancers. Vadim Backman
New methods based on standard protein biomarkers used for the detection of cancer do not provide sufficient sensitivity and specificity. Recently, there has been significant interest in the development of protocols that rely on tumor secretions in the blood, such as liquid biopsy. These tests identify cancer by analyzing circulating tumor DNA. Although initial results have shown promise in the detection of various cancers, including lung cancer, the sensitivity to Stage-I and smaller lesions drops precipitously below a clinically acceptable level. It has been suggested that this is not primarily a technological limitation, but may instead be related to the biology of the source and type of biomarker.
"The ability to detect nanoscale chromatin alterations associated with carcinogenesis as a biomarker, on the other hand, means that we can potentially identify the initiation of cancer when its earliest genomic events occur, before lesions or tumors form," Backman said. "This is the most clinically useful stage for screening because of the major improvement in prognosis and mortality that come with earlier diagnosis. In addition, a simple self-administered test may have benefits in terms of reducing stigma, cost, and access issues associated with the extremely poor uptake that currently exists among the LDCT screening-eligible population.
"In the big picture, this is a radically new approach to cancer screening and early detection with implications for a range of other major cancers."
A paper supporting this work, titled "Early Detection of Lung Cancer Using Artificial Intelligence-Enhanced Optical Nanosensing of Chromatin Alterations in Field Carcinogenesis," was published in August in Scientific Reports, a Nature journal. The research was carried out with funding from the National Institutes of Health (grant #U54CA268084 and T32GM142604) and the National Science Foundation (grant #EFMA-1830961).
Experts Recommend Urgent Shift To Low-dose CT Screening To Detect Lung Cancer Earlier
As per a new consensus by 19 experts across Asia, use of a low dose computed tomography (LDCT) scan can significantly reduce the number of deaths caused due to lung cancer. The study published in the Journal of Thoracic Oncology, stated that fatality caused by the lung cancer could be reduced by ensuring earlier diagnosis through improved screening access and changes to how people are screened. Among their recommendations, which were shared at the World Conference on Lung Cancer being held in Singapore this week, experts urge a shift from traditionally used chest X-rays to a more advanced procedure known as LDCT, which uses a computer with low dose X-rays to generate a series of pictures and can help to detect lung abnormalities, including tumours. The consensus is the result of extensive discussion among experts from Hong Kong, India, Indonesia, Japan, Malaysia, the Philippines, Singapore, South Korea, Taiwan, Thailand, Vietnam, backed by the Lung Ambition Alliance (LAA), a non-profit collaboration between the International Association for the Study of Lung Cancer (IASLC), the Global Lung Cancer Coalition (GLCC), AstraZeneca, and Guardant Health. The experts also called for improvements to the incorporation of smoking cessation programmes alongside lung cancer screening programmes. In most parts of Asia, LDCT is still not implemented in routine lung cancer screening programs due to challenges such as perceived cost, reimbursement, lack of infrastructure and trained staff, reluctance of eligible high-risk individuals, as well as absence of well-defined guidelines. Dr. Anil Kukreja, vice president, medical regulatory affair, AstraZeneca said "Empowering lives and defeating lung cancer in India hinges on one crucial element which is early detection. The implementation of risk prediction models and AI-supportive modalities to boost the efficacy of screening and follow-up with LDCT was another recommendation by the experts to overcome the lack of access challenges. In India, implementing LDCT is a challenge, but we are leveraging AI for screening, and it can be a modality which will help in early diagnosis. Currently with our partners like Qure.Ai, we are improving access and their technology is already implemented in few states. By enhancing access to lung screening programs and establishing standardized protocols, we stand resolute in the fight against lung cancer, leaving a profound and lasting impact on integrated lung healthcare, he added. Qure.Ai, has deployed AI-enabled chest imaging solutions that can detect nodules and flag the malignancy risk of the nodule using their proprietary lung nodule malignancy score based on the nodule characteristics. Prashant Warier, co-founder and CEO of Qure.Ai, "We are looking forward to seeing more such discourses shaping up new paradigms of clinical care when it comes to defeating lung cancer. By harnessing the power of AI and advanced imaging, we aim to transform how incidental pulmonary nodules are identified and categorized, enabling clinicians to discern high or low risk of lung cancer swiftly." We are committed to redefining healthcare paradigms and enhancing patient outcomes through cutting-edge AI solutions. Our partnership with AstraZeneca is a perfect example of creating such real impact," he added. According to the consensus, patients with detected screening abnormalities while undergoing routine health screening and persistent exposure to risk factors are recommended to be screened with LDCT annually, while high-risk heavy smokers should do so twice a year. To overcome these difficulties, the experts recommend improving access to lung screening programmes and subsequent care by having a standardised protocol for follow-up LDCT scans and consideration for integrated lung healthcare, such as a national screening programme.
Taiwan Launches National Lung Cancer Early Detection Program Detects 85 Percent Of Lung Cancer Cases At Early Phase
image: Pan-Chyr Yang, MD, PhD from the National Taiwan University Hospital view more
Credit: Pan-Chyr Yang, MD, PhD from the National Taiwan University Hospital
First-ever National Screening Program to Consider Family History
(Singapore – 10:05 a.M. SGT--September 11, 2023) – The Taiwan National Lung Cancer Early Detection Program detected 85 percent of lung cancer cases at either a phase 0 or phase 1 level, demonstrating that lung cancer screening can detect lung cancer at an early enough phase to allow doctors to intervene more effectively.
The results of the program were presented by Pan-Chyr Yang, MD, PhD from the National Taiwan University Hospital, at the International Association for the Study of Lung Cancer 2023 World Conference on Lung Cancer today in Singapore.
Lung cancer continues to be the leading cause of cancer-related deaths both globally and in Taiwan. To combat lung cancer and improve survival rates, Taiwan has taken a groundbreaking step by introducing the "Taiwan National Lung Cancer Early Detection Program." This program aims to detect lung cancer early through low-dose computed tomography (LDCT) lung cancer screening, targeting individuals with a family history of lung cancer and those with a history of heavy smoking.
Timely detection is crucial to improving lung cancer outcomes, and LDCT lung cancer screening has been proven effective in reducing mortality rates, particularly among heavy smokers. However, the existing screening criteria in the United States and South Korea limit eligibility to heavy smokers only, leaving a substantial portion of the population at risk.
The Taiwan Lung Cancer Screening for Never-Smoker Trial (TALENT) provided critical insights that family history of lung cancer is a significant risk factor for developing lung cancer in Taiwan. Building on this knowledge, Taiwan launched its national lung cancer screening program in July 2022, targeting two specific eligible populations:
1) Individuals with a family history of lung cancer: Specifically, men aged between 50 and 74 years and women aged between 45 and 74 years, whose parents, children, or siblings have been diagnosed with lung cancer.
2) Individuals with a history of heavy smoking: Specifically, individuals aged between 50 and 74 years with a smoking history of 30 or more pack-years, who are willing to quit smoking or have quit within the past 15 years.
The program utilizes a modified Lung-RADS guideline of the American College of Radiology (ACR) as the nodule management guideline and established a case management system to ensure appropriate follow-up for positive screening results. The collected data includes risk factors, image interpretation results, and evaluation outcomes, which are used to facilitate timely diagnosis and treatment.
Preliminary results from July 2022 to June 2023, have been promising according to Director General, Chao-Chun Wu, from the Health Promotion Administration of Taiwan. A total of 49,508 individuals were screened, with 28,617 (58%) having a family history of lung cancer and 18,970 (38%) being heavy smokers. Of those screened, 4,406 individuals received a positive screening result, and 531 individuals were ultimately diagnosed with lung cancer. The positive rate was 9.2%, and the lung cancer detection rate was 1.1%, with an impressive 85% of lung cancer cases diagnosed at an early stage (stage zero and one).
The Taiwan National Lung Cancer Early Detection Program is a significant step forward in the fight against lung cancer, offering hope for saving lives through early detection and improved treatment outcomes," Dr. Yang said.
About the IASLC:
The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated solely to the study of lung cancer and other thoracic malignancies. Founded in 1974, the association's membership includes more than 8,000 lung cancer specialists across all disciplines in over 100 countries, forming a global network working together to conquer lung and thoracic cancers worldwide. The association also publishes the Journal of Thoracic Oncology, the primary educational and informational publication for topics relevant to the prevention, detection, diagnosis, and treatment of all thoracic malignancies. Visit www.Iaslc.Org for more information.
About the WCLC:
The WCLC is the world's largest meeting dedicated to lung cancer and other thoracic malignancies, attracting more than 7,000 researchers, physicians, and specialists from more than 100 countries. The goal is to increase awareness, collaboration, and understanding of lung cancer, and to help participants implement the latest developments across the globe. The conference will cover a wide range of disciplines and unveil several research studies and clinical trial results. For more information, visit https://wclc2023.Iaslc.Org.
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