Lam David Chi-Leung, Liam Chong-Kin, Andarini Sita, Park Samina, Tan Daniel S W, Singh Navneet, Jang Seung Hun, Vardhanabhuti Varut, Ramos Antonio B, Nakayama Tomio, Nhung Nguyen Viet, Ashizawa Kazuto, Chang Yeun-Chung, Tscheikuna Jamsak, Van Cong Cung, Chan Wai Yee, Lai Yeur-Hur, Yang Pan-Chyr
Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China.
Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
J Thorac Oncol. 2023 Oct;18(10):1303-1322. doi: 10.1016/j.jtho.2023.06.014. Epub 2023 Jun 28.
The incidence and mortality of lung cancer are highest in Asia compared with 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 health care investment and policies, make it necessary to have a more specific approach for screening, early detection, diagnosis, and treatment of patients with lung cancer in Asia compared with 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 to 75 years and smoking history of more than or equal to 20 pack-years. Family history is the most common risk factor for nonsmokers. Low-dose computed tomography 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 nonsmokers 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 more than 80 years of age or are unable or unwilling to undergo curative treatment.
Asian countries face several challenges in implementing low-dose computed tomography 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.
与欧洲和美国相比，亚洲肺癌的发病率和死亡率最高，东亚地区的发病率和死亡率分别为每10万人34.4例和28.1例。早期诊断肺癌可使疾病接受根治性治疗并降低死亡率。在亚洲的一些地区，强大的诊断工具和治疗方式的可用性有限，再加上特定医疗保健投资和政策的差异，因此与西方相比，有必要针对亚洲肺癌患者采用更具针对性的筛查、早期检测、诊断和治疗方法。
来自11个亚洲国家的19名不同专业的顾问参加了一次虚拟指导委员会会议，讨论并推荐了最经济实惠且可及的肺癌筛查方式及其在亚洲人群中的实施方法。
在亚洲吸烟者中确定的肺癌重要危险因素包括年龄在50至75岁之间以及吸烟史大于或等于20包年。家族史是非吸烟者最常见的危险因素。对于筛查发现异常且持续暴露于危险因素的患者，建议每年进行一次低剂量计算机断层扫描筛查。然而，对于高危重度吸烟者和有危险因素的非吸烟者，建议最初每隔6至12个月进行一次重新评估扫描，随后延长重新评估间隔时间，对于80岁以上或无法或不愿意接受根治性治疗的患者应停止筛查。
亚洲国家在实施低剂量计算机断层扫描筛查方面面临若干挑战，如经济限制、早期检测力度不足以及缺乏特定的政府项目。建议采取各种策略来克服亚洲的这些挑战。
