Should current lung cancer screening inclusion criteria be reviewed? Evidence from LUCIA cohort

Introduction

Lung cancer (LC) is the leading cause of cancer-related mortality, largely due to late-stage diagnosis. Thus, early detection improves outcomes and survival. Low-dose computed tomography (LDCT) enables early detection in high-risk populations, although many LC cases fall outside current screening criteria. This study evaluates the need to reassess European inclusion criteria for a LC screening program.

Methods

The LUCIA Project is a prospective study with 1.5 years of follow-up in a general population between 40 and 80 years old without cancer in the previous 5 years. Baseline findings from the Basque Country cohort are presented. Demographic variables, risk factors and radiological results (Lung-RADS) were analyzed.

Results

A total of 1,359 individuals aged 40–80 (IQR: 47–61) were included; 40.5% men and 59.5% women. 26.9% were never smokers, 47.2% former smokers and 25.9% smokers at the baseline analysis. Asbestos exposure was reported in 6.8%. Occupational exposure to smoke was present in 51.3% and in 15.9% at home. A family history of LC was reported in 32.7% of the participants. According to the Lung-RADS classification, the following were identified: 105 of category 1, 308 category 2, 12 category 2D, 31 category 3, and 5 category 4A. Besides, four LC cases were detected (64–72 years; 2 men and 2 women); one was smoker and three former smokers (two of them from more than 25 years ago). All four had been exposed to smoke at work and two also at home. Three had a family history of LC. None had prior lung disease or asbestos exposure. All cases were diagnosed at early-stage (IA).

Conclusions

Firstly, LDCT screening identified stage IA LC in a general population, supporting its potential to reduce mortality. Secondly, passive smoke exposure and family history may be relevant variables beyond the current criteria established by the European Union.

Key messages

• The LUCIA cohort demonstrated that LDCT successfully detects lung cancer in early stages (IA), even in patients who do not meet current European Union risk criteria.

• Results conclude inclusion criteria for LC early detection should be reviewed, integrating key factors such as exposure to environmental smoke and medical history of the disease.