Low-Dose Computed Tomography Screening in Relatives With a Family History of Lung Cancer

Chi-Liang Wang; Kuo-Hsuan Hsu; Ya-Hsuan Chang; Chao-Chi Ho; Chun-Ju Chiang; Kun-Chieh Chen; Yun-Chung Cheung; Pei-Ching Huang; Yu-Ruei Chen; Chih-Yi Chen; Chung-Ping Hsu; Jiun-Yi Hsia; Hsuan-Yu Chen; Shi-Yi Yang; Yao-Jen Li; Tsung-Ying Yang; Jeng-Sen Tseng; Cheng-Yen Chuang; Chao A Hsiung; Yuh-Min Chen; Ming-Shyan Huang; Chong-Jen Yu; Kuan-Yu Chen; Wu-Chou Su; Jeremy J W Chen; Sung-Liang Yu; Chien-Jen Chen; Pan-Chyr Yang; Ying-Huang Tsai; Gee-Chen Chang

doi:10.1016/j.jtho.2023.06.018

Low-Dose Computed Tomography Screening in Relatives With a Family History of Lung Cancer

J Thorac Oncol. 2023 Nov;18(11):1492-1503. doi: 10.1016/j.jtho.2023.06.018. Epub 2023 Jul 5.

Authors

Chi-Liang Wang¹, Kuo-Hsuan Hsu², Ya-Hsuan Chang³, Chao-Chi Ho⁴, Chun-Ju Chiang⁵, Kun-Chieh Chen⁶, Yun-Chung Cheung⁷, Pei-Ching Huang⁷, Yu-Ruei Chen⁸, Chih-Yi Chen⁹, Chung-Ping Hsu¹⁰, Jiun-Yi Hsia¹¹, Hsuan-Yu Chen¹², Shi-Yi Yang¹³, Yao-Jen Li¹⁴, Tsung-Ying Yang¹⁵, Jeng-Sen Tseng¹⁶, Cheng-Yen Chuang¹⁷, Chao A Hsiung¹⁸, Yuh-Min Chen¹⁹, Ming-Shyan Huang²⁰, Chong-Jen Yu²¹, Kuan-Yu Chen²², Wu-Chou Su²³, Jeremy J W Chen²⁴, Sung-Liang Yu²⁵, Chien-Jen Chen¹⁴, Pan-Chyr Yang²⁶, Ying-Huang Tsai²⁷, Gee-Chen Chang²⁸

Affiliations

¹ Division of Pulmonary Oncology and Interventional Bronchoscopy, Department of Thoracic Medicine, Linkou Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan, Taiwan.
² Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
³ Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan; Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
⁴ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan.
⁵ Taiwan Cancer Registry, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
⁶ Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan; Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
⁷ Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan, Taiwan.
⁸ Department of Medical Imaging, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.
⁹ Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan.
¹⁰ Division of Thoracic Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Hualien, Taiwan; Division of Thoracic Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
¹¹ School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan.
¹² Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
¹³ Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Genomics Research Center, Academia Sinica, Taipei, Taiwan.
¹⁴ Genomics Research Center, Academia Sinica, Taipei, Taiwan.
¹⁵ Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan.
¹⁶ Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung; Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁷ Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
¹⁸ Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
¹⁹ School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
²⁰ Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan; School of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
²¹ Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan.
²² Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
²³ Department of Oncology, National Cheng Kung University Hospital, Tainan, Taiwan; College of Medicine, National Cheng Kung University, Tainan, Taiwan.
²⁴ Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan.
²⁵ Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Medical Device and Imaging, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
²⁶ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan; Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
²⁷ Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan; Department of Pulmonary and Critical Care, Xiamen Chang Gung Hospital, Xiamen, People's Republic of China.
²⁸ Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. Electronic address: cshy1888@csh.org.tw.

PMID: 37414358
DOI: 10.1016/j.jtho.2023.06.018

Abstract

Introduction: The role of a family history of lung cancer (LCFH) in screening using low-dose computed tomography (LDCT) has not been prospectively investigated with long-term follow-up.

Methods: A multicenter prospective study with up to three rounds of annual LDCT screening was conducted to determine the detection rate of lung cancer (LC) in asymptomatic first- or second-degree relatives of LCFH.

Results: From 2007 to 2011, there were 1102 participants enrolled, including 805 and 297 from simplex and multiplex families (MFs), respectively (54.2% women and 70.0% never-smokers). The last follow-up date was May 5, 2021. The overall LC detection rate was 4.5% (50 of 1102). The detection rate in MF was 9.4% (19 of 202) and 4.4% (4 of 91) in never-smokers and in those who smoked, respectively. The corresponding rates for simplex families were 3.7% (21 of 569) and 2.7% (6 of 223), respectively. Of these, 68.0% and 22.0% of cases with stage I and IV diseases, respectively. LC diagnoses within a 3-year interval from the initial screening tend to be younger, have a higher detection rate, and have stage I disease; thereafter, more stage III-IV disease and 66.7% (16 of 24) with negative or semipositive nodules in initial computed tomography scans. Within the 6-year interval, only maternal (modified rate ratio = 4.46, 95% confidence interval: 2.32-8.56) or maternal relative history of LC (modified rate ratio = 5.41, 95% confidence interval: 2.84-10.30) increased the risk of LC.

Conclusions: LCFH is a risk factor for LC and is increased with MF history, among never-smokers, younger adults, and those with maternal relatives with LC. Randomized controlled trials are needed to confirm the mortality benefit of LDCT screening in those with LCFH.

Keywords: Early onset lung cancer; Family history of lung cancer; Low-dose computed tomography; Lung cancer screening; Never smokers.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Early Detection of Cancer / methods
Female
Humans
Lung Neoplasms* / diagnostic imaging
Lung Neoplasms* / epidemiology
Lung Neoplasms* / genetics
Male
Mass Screening
Prospective Studies
Risk Factors
Tomography, X-Ray Computed / methods