Lung cancer remains one of the leading causes of cancer-related mortality worldwide, affecting not only smokers but also never smokers. Lung cancer screening (LCS) is a vital tool in early detection and prevention, particularly for those who may be at risk but have never smoked.

What Does Lung Cancer Screening Involve?

Lung cancer screening typically involves imaging tests, primarily low-dose computed tomography (LDCT), which can detect lung cancer at earlier stages than traditional methods. This process allows healthcare providers to identify potential malignancies before they progress to advanced stages, thereby increasing the chances of successful treatment.

Who Should Be Screened?

Current guidelines recommend lung cancer screening for individuals aged 50 to 80 years who have a significant history of smoking (30 pack-years or more) and are either still smoking or have quit within the past 15 years. However, this raises a critical question: what about never smokers who may also be at risk? Evidence suggests that certain criteria, such as family history of lung cancer and exposure to carcinogenic substances, may warrant screening in this population.

Common Risks and Factors Associated with Lung Cancer

While smoking is the primary risk factor for lung cancer, never smokers can also be affected. Common risk factors include:

– Family history of lung cancer
– Exposure to secondhand smoke
– Occupational exposure to carcinogens (e.g., asbestos, radon)
– Air pollution
– Genetic predisposition

With the increasing incidence of lung cancer among never smokers, understanding these risk factors is crucial for developing effective screening strategies.

Significant Studies on Lung Cancer Screening

Several major studies have demonstrated the efficacy of lung cancer screening in reducing mortality rates:

– The National Lung Screening Trial (NLST) (n=53,454): Showed a 20% reduction in lung cancer mortality.
– The Dutch–Belgian Randomized Lung Cancer Screening Trial (NELSON) (n=15,792): Reported a 24% reduction in lung cancer mortality.
– The Italian Lung (ITALUNG) Screening Trial (n=3,206): Demonstrated a 30% reduction in mortality.
– The Multicentric Italian Lung Detection (MILD) trial (n=4,099): Achieved a remarkable 39% reduction in lung cancer mortality.

These studies provide compelling evidence for the effectiveness of lung cancer screening using LDCT in high-risk populations.

The Situation in the Republic of Moldova

In the Republic of Moldova, the lack of lung cancer screening programs, including low-dose CT and chest X-ray, presents a significant public health concern. The absence of these essential screening tools could lead to delayed diagnoses and increased mortality rates among the population, particularly among never smokers who may be at risk.

Conclusion

According to the evidence of increasing lung cancer incidence among never smokers, a lung cancer screening (LCS) strategy for never smokers with high-risk factors should be initiated. Transitioning from clinical trials to population-based lung cancer screening demonstrates the rationale for adopting family history of lung cancer (FHLC) as a criterion for LCS. Additionally, a risk stratification model may be developed based on air pollution, polygenic risk scores (PRS), and selected patient groups, such as breast cancer survivors. Implementing these strategies could significantly improve early detection and reduce mortality rates associated with lung cancer in never smokers.