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Screening-Detected Versus Interval Lung Cancer in the Biennial Korean National Lung Cancer Screening Program:
Hyungjin Kim1, Eunseo Jo2, Jinseob Kim2
1Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea.
Summary
Interval lung cancers (ILCs) are common in biennial lung cancer screening (LCS) for Asian populations, indicating potential suboptimality for heavy smokers. These cancers, diagnosed between screenings, show higher mortality than screen-detected cancers.
Area of Science:
- Oncology
- Radiology
- Public Health
Background:
- Interval lung cancers (ILCs) are crucial for evaluating lung cancer screening (LCS) effectiveness.
- Limited data exists on ILCs in Asian populations undergoing biennial screening.
Purpose of the Study:
- To determine the proportion, characteristics, and mortality of ILCs in a Korean biennial LCS program.
- To identify risk factors associated with ILC development.
- To compare mortality between ILCs and screening-detected lung cancers (SLCs).
Main Methods:
- Analysis of 124,595 participants in the Korean national LCS program (2019-2020).
- Definition of SLCs (diagnosed within 1 year of positive screen) and ILCs (diagnosed >1 year after negative screen, before next screen).
- Multivariable logistic and Cox regression analyses for risk factors and mortality.
Main Results:
- ILCs occurred in 0.17% of participants, accounting for 18.5% of all lung cancers within 2 years.
- Older age, smoking history, prior malignancy, emphysema, and interstitial lung abnormalities were significant ILC risk factors.
- ILCs exhibited higher all-cause mortality compared to SLCs (aHR=1.43).
Conclusions:
- Biennial LCS may be suboptimal for detecting lung cancers in Asian heavy smokers due to a notable proportion of ILCs.
- ILCs represent a significant burden and are associated with increased mortality, necessitating further research into screening interval optimization.
