A doctor gives a check-up to a patient at HCM City Oncology Hospital. Doctors recommend earlier diagnosis for better lung cancer treatment. — Photo from benhvienungbuou.vn

HCM CITY — Deaths caused by lung cancer in Asia could be reduced by ensuring earlier diagnosis through improved screening access and changes to how people are screened, according to a new consensus by 19 experts from across Asia, published in the Journal of Thoracic Oncology.

Among recommendations, experts urge a shift from traditionally used chest X-rays to a more advanced procedure known as low-dose computed tomography (LDCT), which uses a computer with low dose X-rays to generate a series of pictures that can help detect lung abnormalities, including tumours.

These changes will be significant in helping to protect lives in Asia, given that approximately three in five cases of lung cancer occur within the region, representing more than 1.3 million patients.

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.

World Health Organisation’s International Agency for Research on Cancer reported that there are over 180,000 new cancer cases in Việt Nam alone each year, among which approximately 26,000 cases are lung cancer.

“The key to reducing lung cancer deaths in Việt Nam and Asia is early detection, when doctors can offer patients highly effective treatment regimens that can even cure the disease. It means that with earlier detection, there is also a higher chance of cure,” said Associate Professor, PhD Nguyễn Viết Nhung, head of the Lung Department, University of Medicine and Pharmacy, Hà Nội National University and president of the Việt Nam Lung Association.

In Việt Nam, he said, lung cancer screening with LDCT has been recommended in the “Guidelines for the diagnosis and treatment of non-small cell lung cancer” by the Ministry of Health since 2018.

However, he added: “The practice so far is limited. The expert consensus in Asia, once again, urges us to act more aggressively and urgently, and it is critical that LDCT screening is employed as the main screening tool. Smokers of 20 packs per year or more, or non-smokers with a family history of lung cancer, aged 50–75 years, should be included in this lung-cancer screening programme, if we are to urgently save more lives from lung cancer.”

In most parts of Asia, LDCT is still not implemented in routine lung cancer screening programmes due to challenges such as perceived cost, lack of infrastructure and trained staff, reluctance of high-risk individuals, as well as absence of well-defined guidelines.

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.

And while smoking is the leading risk factor, lung cancer among never-smokers accounts for a substantial proportion of cases, especially among Asian women.

In addition, non-smoking lung cancer patients in Asia are more likely to be diagnosed at an earlier age compared with current and former smokers.

Therefore, the experts agree that it is necessary to support high-risk patients to access screening procedures, irrespective of their smoking status, by considering factors such as genetics and demographics.

Documenting country-specific evidence on risk factors among never-smokers, which include age, family history of lung cancer, history of other cancers, second-hand smoke, and exposure to indoor cooking and heating fumes and outdoor air pollution, could also help garner government support in establishing a lung cancer screening programme locally, doctors note.

The consensus is the result of extensive discussion among experts from Hong Kong, India, Indonesia, Japan, Malaysia, the Philippines, Singapore, South Korea, Taiwan, Thailand and Việt Nam, backed by the Lung Ambition Alliance (LAA).

The LAA is 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. — VNS