42O - Implementation of organized lung cancer screening program in Korea

Abstract

Background: Lung cancer is the leading cause of cancer mortality worldwide and has a low survival rate due to difficulties cocnerning early detection. The Korean Lung Cancer Screening demonstration project (K-LUCAS) was started in February 2017. K-LUCAS will assess the effectiveness, harm, and feasibility of lung cancer screening in order to implement a population-based screening program. K-LUCAS will evaluate the validation of the new standard of reporting form of low-dose computed tomography (LDCT) and the quality of lung cancer screening by a web-based network system using computer-aided nodule detection program (CAD). Methods: K-LUCAS is a population-based single arm trial conducted in 14 cancer hospitals that targets a high-risk population aged 55-74 years with at least 30 pack-year smoking history within the last 15 years. Participants were recruited when visiting the national cancer screening center or smoking cessation clinics based on a lung cancer risk evaluation questionnaire. Lung cancer screening was provided by LDCT with at least a 16-row multidetector CT scanner and screening results were reported by Lung Imaging Reporting and Data System (Lung-RADS). All participants should have their results explained to them by a physician and current smokers should receive smoking cessation counselling. Results: Up until November 2018, 13,491 participants had joined K-LUCAS. The positive screening rate (categories 3 and 4 in Lung-RADS) was 15.3%. Among these, 69 lung cancers were detected and stage I and II lung cancers were 53.6% and 15.9%, respectively. CAD detects more positive findings but decreases the variation of positive rate among screening units. About 75% of abnormal findings, including emphysema, coronary artery calcification etc. besides lung nodules, were detected in K-LUCAS. Conclusions: K-LUCAS shows promising results in effective detection of early stage lung cancer and controlling diagnosis quality by a web-based network system. Based on the observations from K-LUCAS, a decision will be made as to whether lung cancer screening will be included in national cancer screening program. Clinical trial identification: NCT03394703. Legal entity responsible for the study: The author. Funding: Ministry of Health and Welfare, Republic of Korea. Disclosure: The author has declared no conflicts of interest.