Opportunities and challenges for lung cancer screening in China

Opportunities and challenges for lung cancer screening in China

Chuanli Ren, Chongxu Han


China accounts for nearly half of the incidence and mortality of lung cancer in the world. Furthermore, trends in lung cancer in China are increasing younger in age and the situation is deteriorating. As a whole although screening for early lung cancer may cause a small fraction of overdiagnosis and anxiety of the population, screening for lung cancer can significantly reduce the mortality of the leading malignant disease. Large scale screening usually faces the diameters of small pulmonary nodules less than 10 millimeters of which the malignant feature can’t be directly judged. Follow up the status of these suspicious small nodules and select and the ideal treatment model. China must take measures to avoid lagging behind developed courtiers in combating with this malignant disease which is deteriorating.

An estimated 733,300 new cases of lung cancer and 610,200 related fatalities occur in China each year.1 The number of cases in China accounts for almost half of the total cases worldwide. Furthermore, the incidence of lung cancer in China is increasing, and patients are becoming younger.

It is found in the National Lung Screening Trial in the United States that lung cancer mortality decreased by 20.0% when low-dose computed tomography (LDCT) was used to screen, rather than chest radiography.2 The United States Preventive Services Task Force recommended that annual LDCT screening be implemented for adults aged 55–80 years according to their pack-years of smoking and general health status, and 30-plus pack-years is set as one of the eligibility criteria.34 However, screening may have some negative impacts as a result of overdiagnosis and overtreatment for lung cancer without clinical symptoms. Over 18% of all lung cancers identified by LDCT may represent an overdiagnosis.5

Overall, although screening for early lung cancer may result in a small fraction of overdiagnosed cases and lead to patient anxiety, lung cancer screening can significantly reduce the mortality of the leading malignant disease. Screening can identify a proportion of patients with early-stage disease who are able to undergo curative therapy timely; which could lead to the increase in the overall survival rate.

Bearing the world’s highest burden for lung cancer, China should now accelerate its LDCT screening throughout all the provinces. Over 300 million Chinese men smoke, and 740 million non-smokers of both sexes are subject to second-hand smoking.6 In 2015, China was one of the top three countries in terms of total number of both male and female smokers.7 Public health education programmes can help decrease the smoking population and the harm caused by second-hand smoking in public places.8 Public health education and government action could encourage more people to quit smoking; the high-risk population could undergo LDCT screening to identify early-stage lung cancer. The Chinese have traditionally refused to undergo screening for fear of being diagnosed with incurable cancer or being unable to afford medical expenses. The Chinese government has promoted health-care reform, and the fee for LDCT examinations has decreased remarkably to less than US$60. Both insurance schemes and social health programs include LDCT screening as a general physical examination item for adults now. Such steps have made considerable progress in identifying early-stage lung cancer in China where lung cancer screening has greater potential for success than gastric cancerscreening.9

Large-scale screening is usually able to detect small pulmonary nodules less than 10 mm in size whose malignant features cannot be directly determined. It is necessary to follow up on the status of such suspicious small nodules and implement an appropriate treatment model. If the condition of such small nodules deteriorates or new nodules are detected, there is a high probability of lung cancer, and surgery is the best option.10

With China’s economic development and reform of its medical health system, the government must undertake measures to avoid lagging behind developed countries in combating this malignant disease.

We declare no competing interests.


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