Globally, lung cancer is more than just a disease; it is the leading cause of cancer-related deaths worldwide, with the highest mortality rate for both men and women. To combat this, lung cancer screening programs have emerged globally. These programs go beyond simple screening; they represent humanity's effort to significantly improve survival rates through early detection.
Due to the lack of noticeable symptoms in early stages, lung cancer is challenging to detect. However, screening programs targeting high-risk individuals and providing regular examinations can improve early diagnosis rates. In particular, LDCT (low-dose chest CT) screening plays a key role in lung cancer screening programs, overcoming the limitations of traditional chest X-ray examinations and greatly increasing the chances of detecting lung cancer in its early stages. However, LDCT screening alone cannot solve all the problems. Artificial intelligence (AI) technology has begun to be introduced to improve the accuracy and efficiency of image analysis.
How will AI technology shape the evolution of lung cancer screening programs, and what impact will this have on the future of healthcare?
In February 2024, the International Agency for Research on Cancer (IARC), part of the World Health Organization (WHO), released cancer patient statistics from 115 countries worldwide in 2022. According to these statistics, lung cancer is the most common cancer worldwide, with 2.5 million new cases (12.4% of all new cases) in 2022, followed by breast cancer in women (2.3 million, 11.6%), colorectal cancer (1.9 million, 9.6%), prostate cancer (1.5 million, 7.3%), and stomach cancer (970,000, 4.9%).
In men, lung cancer represents 11% of all cancer diagnoses, with a 20% mortality rate. For women, it represents 12% of all cancer diagnoses, but the mortality rate is much higher at 21%. The high mortality rate is primarily due to late-stage diagnoses. The higher rate of stage 4 diagnosis limits treatment options, and survival rates drop dramatically. Thus, early detection of lung cancer is critical, and a systematic lung cancer screening program is essential.
Early-stage lung cancer is difficult to detect due to the lack of noticeable symptoms, often leading to diagnoses at advanced stages, which are difficult to treat. In addition, traditional chest X-rays have limited early detection capabilities, and standard chest CT scans pose a burden due to high radiation exposure.
Rigorous research and clinical trials have demonstrated the global interest in effective lung cancer screening, with two key studies playing a decisive role. Two randomized controlled trials, including the National Lung Screening Trial (NLST) in the US and the NELSON trial in Europe, have shown that low-dose CT can reduce lung cancer deaths.
This is low-dose CT (LDCT) screening, which stands for low-dose chest computed tomography (CT). It is a screening method that significantly reduces radiation exposure compared to a typical chest CT scan and is intended for early detection of lung cancer.
National Lung Screening Trial (NLST): This large U.S. study involving 53,450 people showed a significant 20% reduction in lung cancer mortality among those who received LDCT screening compared to those who received chest X-rays. The NLST also found that overall mortality was reduced by about 7%, emphasizing the importance of early detection of lung cancer.
NELSON trial: The NELSON trial, conducted in Europe, showed the effectiveness of LDCT screening in more than 15,000 participants (13,000 men and 2,600 women). The trial confirmed a significant reduction in lung cancer mortality with LDCT screening, highlighting a 50-60% stage I lung cancer detection rate, which is a significant improvement in early detection.
Based on these NLST results, many lung cancer organizations have recommended lung cancer screening with LDCT in high-risk groups. The United States, Europe, and South Korea have already adopted it as a national program.
United States: The United States has adopted LDCT screening as the official method of early lung cancer screening, with guidelines from the U.S. Preventive Services Task Force (USPSTF) and the Centers for Medicare and Medicaid Services (CMS) to select screening candidates.
Europe: In Europe, countries have varying levels of lung cancer screening adoption, but several countries are considering LDCT screening based on the NELSON trial.
South Korea: South Korea has been operating a national lung cancer screening program since 2019, offering LDCT screening to high-risk smokers aged 55-74 years.
Recently, artificial intelligence (AI) technology has been applied to LDCT analysis to enhance the accuracy of lung cancer screening. In addition to the U.S., South Korea, and Taiwan, the number of countries with national lung cancer screening programs has recently expanded to include Germany, the U.K., France, Australia, and Slovakia. These countries are especially encouraging the use of AI solutions by prioritizing AI-based cancer diagnosis and treatment technologies that address current limitations.
Further reading
While the fight against lung cancer continues, advancements in LDCT screening and AI technology are leading us towards unprecedented progress. Emphasis on early detection and the continuous improvement of the efficiency and accuracy of AI-enhanced screening programs are crucial. Through continued research and technological innovation, we look forward to creating a world without lung cancer.
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