Abstract
Lung cancer remains the leading cause of cancer-related death worldwide. Preventive strategies, mainly smoking cessation have a big impact on the reduction of lung cancer-related mortality. Screening with low dose computed tomography (LDCT) has proven to be beneficial in reducing the mortality related to lung cancer mainly based on early detection of cancer and timely initiation of treatment. Despite its beneficial effects, guideline-directed LDCT screening could lead to high false positive results, subjecting patients to harmful radiation, increase cost of healthcare and induce anxiety amongst the patients. Thus, it is imperative to look beyond the prevailing modalities of lung cancer screening and diagnosis to achieve better yield and mitigate the existent drawbacks.
Highlights
With the surge in awareness regarding detrimental effects of cigarette smoking, developed nations, in particular, have witnessed some downward trend in lung cancer but it still remains a major cause of mortality and morbidity globally with 2.1 million cases and 1.8 million deaths reported in the year 2018 [1]
An analysis performed before the conclusion of National Lung Screening Trial (NLST), estimated the cost to be US $ 126,000 to $ 269,000 per quality of adjusted life year (QALY) for lung cancer screening to obtain a reduction in lung cancer mortality by up to 25% at 10 years [20]
Newer non-invasive adjunctive tests, based on a better understanding of genomic expressions in lung cancer can play a pivotal role in the future
Summary
With the surge in awareness regarding detrimental effects of cigarette smoking, developed nations, in particular, have witnessed some downward trend in lung cancer but it still remains a major cause of mortality and morbidity globally with 2.1 million cases and 1.8 million deaths reported in the year 2018 [1]. Molecular and protein-based tumor markers obtained from a simple blood test can be utilized in the context of incidentally diagnosed pulmonary nodules that are likely to be benign [30] This might help physicians to categorize patients in low to moderate risk groups for malignancy, instead of subjecting them to invasive testing. Silvestri and colleagues in PANOPTIC study [30] utilized the blood-based molecular test for incidental lung nodules ranging between 8 to 30 mm in size and a pre-test risk of malignancy less than or equal to 50% determined by solitary pulmonary nodule calculator [31] This test utilized the mass spectrometry to identify two circulating proteins and coupling with clinical risk factors to satisfy the proprietary algorithm to obtain a final result with up to 97% sensitivity and 98% negative predictive value [30]. These techniques carry the potential to be game-changers in lung cancer screening and diagnosis
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