Two doors blocking lung cancer: smoking cessation and screening

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Lung cancer remains the leading cause of cancer-related deaths worldwide, and tobacco consumption is the most important risk factor.Since nearly 90% of lung cancer can be attributed to smoking, tobacco control remains critical to reducing lung cancer morbidity and mortality.Although smoking rates worldwide have declined, it is estimated that there are still nearly 1 billion smokers worldwide.Most lung cancers are diagnosed as locally advanced or metastatic disease and their overall prognosis is still poor.However, early lung cancer can usually be completely treated by surgical resection or radical radiotherapy, and the prognosis is better.In addition to image-based screening, other methods are currently being investigated, such as respiratory-based and biological fluid-based methods for early detection of lung cancer.This article will focus on the latest advances in the prevention, screening and early detection of non-small cell lung cancer (NSCLC).Prevention of lung cancer 01 Smoking cessation Nearly 90% of lung cancer in the world can be attributed to smoking, and tobacco control is still a necessary condition to reduce lung cancer morbidity and mortality.Despite progress in reducing tobacco consumption in the last decade, it is estimated that there are still nearly 1 billion smokers worldwide, 80% of whom live in low- or middle-income countries.Although smoking is still the most common form of tobacco use, other tobacco products (OTPs) such as cigars, hookahs, snuffs, etc. are becoming more common.In recent years, discussions on OTP have focused on electronic cigarettes (ENDS), which has become a replacement for flammable cigarettes and may help to quit smoking.But the impact of long-term use of ENDS remains unclear, especially among young and pregnant users.Most public health experts believe that a complete shift from smoking to e-cigarettes is expected to reduce the health risks associated with smoking, including lung cancer.A recent randomized controlled trial (RCT) in the UK found that e-cigarettes are more effective at quitting smoking than nicotine replacement therapy.Although these results are very encouraging, it is necessary to conduct more research on the potential benefits and hazards of e-cigarettes.There is evidence that continued use of tobacco can have multiple adverse effects on cancer treatment outcomes, including reduced survival, increased probability of recurrence, second primary malignancy, increased disease burden, and poor quality of life.As a result, most major cancer organizations, including the International Association for the Study of Lung Cancer (IASLC), strongly support the recommendation that cancer patients quit smoking and establish evidence-based tobacco treatment.02 Chemoprevention of cancer Chemoprevention is defined as the use of natural or synthetic drugs to block, delay or reverse carcinogenic processes, thereby reducing the risk of cancer in individuals.Based on the success of selective estrogen receptor modulators in preventing and reducing breast cancer risk and the use of aspirin to reduce the incidence of colon cancer, it has been hoped to develop a similar strategy to prevent the development of lung cancer.Over the past two decades, our understanding of the molecular and biological basis of lung cancer has increased significantly, which has greatly improved our ability to develop interventions to reduce the incidence of lung cancer.Unfortunately, the results of phase III clinical trials of lung cancer chemoprevention can be succinctly summarized as: aspirin, retinyl palmitate, cis-retinoic acid, vitamin E, multivitamin and mineral supplements, and selenium are all ineffective.Beta carotene seems to be even harmful to current smoking patients.Iloprost is the only drug that has been shown to improve bronchial dysplasia in Phase II trials. Clinical trials have shown improvement in former smokers, but not in current smokers.Early detection of lung cancer 01 Risk assessment In the past, we used X-ray chest X-rays for screening. According to a large randomized controlled trial from the 1960s to the 1970s, X-ray films can detect more lung cancer and improve the surgical resection rate.However, it does not reduce the mortality rate of lung cancer, so X-ray films are not recommended as a tool for screening lung cancer.In 2011, a randomized controlled trial of the National Lung screening Trial (NLST) showed that screening for high-risk lung cancer patients with low-dose spiral CT (LDCT) compared with X-ray filmsThe case fatality rate dropped by 20%.Based on the results of the trial, a number of authoritative medical organizations in the United States have successively introduced guidelines for lung cancer screening, recommending screening for LDCT lung cancer in high-risk populations.Related studies have shown that LDCT is superior to breast cancer and colorectal cancer screening as a screening method for lung cancer.In order to maximize benefits and minimize potential hazards, an accurate risk assessment is needed to identify individuals most likely to benefit from LDCT screening.At least 22 lung cancer risk prediction tools have been published. One of the most accurate predictive models is the prostate cancer, lung cancer, colorectal cancer and ovarian cancer screening test model 2012 (PLCO m2012) model, which has been carried out internationally.External verification.The PLCO m2012 model addresses risk factors other than age and smoking, such as ethnicity, chronic obstructive pulmonary disease (COPD), family history of lung cancer, and socioeconomic status.Retrospective studies have shown that the use of such tools can increase the sensitivity of screening high-risk lung cancer smokers to 80%.The new data suggests that the US Preventive Services Task Force (USPSTF) or similar NLST age and smoking pack years are not optimal for identifying high-risk individuals.Individualized risk calculations based on demographic, clinical, and smoking characteristics can greatly improve the effectiveness and efficiency of CT screening programs.Therefore, the NCCN’s recent lung cancer screening guidelines allow individuals to be screened using individualized risk models, and different models are used for different screening populations.The global burden of lung cancer is expected to increase in the next few years, especially in East Asia. Because of the large population, the male incidence rate is stable, while the female incidence rate is on the rise, and women who never smoke are dominant.Risk prediction tools need to incorporate other risk factors, such as outdoor and domestic air pollution and genetic susceptibility, which may improve the accuracy of lung cancer risk prediction in Asian populations.02 LDCT LDCT is a hot topic in clinical research at home and abroad in recent years.Compared with ordinary CT plain films, LDCT has the advantage that its radiation dose is only 1/6, but it can detect lung nodules with a diameter of nearly 2mm, the sensitivity is 10 times that of X-ray, and LDCT can be utilized.Computer technology is used to reconstruct the lesions in three dimensions, which is helpful for analyzing the nature of the lesions and following up.In general, LDCT can reduce the radiation exposure time of the examinee and obtain sufficient chest image, so it gradually becomes the main method of lung cancer screening.Since 1990, European and American countries have carried out clinical research on LDCT screening for lung cancer. The current main research includes the new DEPISCAN imaging technology and molecular diagnostic test in France and the screening of early lung cancer, Italian multi-central lung test (MILD),The Danish Lung Cancer Screening Test (DLCST), the Italian Lung Cancer CT Screening Test (ITALUNG), the Dutch Belgian Lung Screening Test (NELSON), and the National Cancer Institute (NCI) National Lung Cancer Screening Test (NLST).NCI published a 6.5-year follow-up of NLST in the New England Journal in August 2011. This multicenter, prospective meta-analysis of lung cancer screening included 53454 subjects in smokers.Regular lung cancer screening was performed using LDCT and X-ray.The results of the study confirmed that high-risk populations received one consecutive three-year LDCT screening, and the mortality rate of lung cancer could be reduced by 20%, thus confirming the importance of LDCT in lung cancer screening and providing an important basis for clinical application.Based on the results of NLST, the National Comprehensive Cancer Network first published a screening guide for lung cancer in October 2011, recommending LDCT screening annually for high-risk groups of lung cancer.In addition, the results of a large RCT NELSON study were announced at the WCLC meeting in 2018. The NELSON study enrolled 53454 high-risk groups. The screening and control groups were 7900 and 7892, respectively. Gender, age, and smoking in the two groups.The number of years of the package is comparable to that of current smokers.CT screening was performed at 1, 2, 4, and 6.5 years, and the control group was in normal mode without screening.The number of patients diagnosed with primary primary lung cancer was significantly greater in the screening group compared with the control group.The proportion of patients in each of the screening, control, and national cancer registries was compared. The results showed that the proportion of patients in stage Ia in the screening group was significantly higher, reaching 50%.Screening for high-risk men can reduce the risk of lung cancer death by 26% (95% CI 9-40%); in women, the risk of reduced mortality is more pronounced, 39-61%.The results of this study are more significant than the results of the NLST study and suggest that the benefits are different for men and women.The results of this study confirm that low-dose CT screening can significantly reduce lung cancer mortality in high-risk previous or current smokers, and both men and women can benefit from screening.In Asia, LDCT lung cancer screening is still under investigation because non-smokers have a higher incidence of lung cancer than in Europe and America.A study conducted in Japan targeted the general population, including non-smokers/light smokers between the ages of 50 and 74, and lung cancer morbidity and mortality and all-cause mortality for LDCT and chest X-rays.We conducted a survey.The study showed that compared with chest X-ray, LDCT lung cancer increased by 23% and lung cancer-specific mortality by 51%.In addition, all-cause mortality associated with LDCT screening was reduced by 43%.South Korea’s pilot study of the Lung Cancer Screening Program (K-LUCAS) announced that nationwide LDCT lung cancer screening began in July 2019.The Chinese Early Cancer Screening (CHANCES) trial (lung cancer, colorectal cancer) was launched in the spring of 2019. Its main purpose is to (1) study the efficacy of LDCT lung cancer screening in reducing lung cancer and lung cancer mortality in high-risk populations (2)The effectiveness of different screening intervals (3) to determine the best option for lung cancer screening in Chinese population.Improving the accurate detection rate of lung nodules, reducing the rate of false positives and improving the efficiency of radiologists are the three major challenges in implementing LDCT screening.In recent years, artificial intelligence, machine learning and deep learning techniques have made rapid progress.Several recent studies have shown that all three techniques can significantly improve the detection rate of pulmonary nodules, including non-nodular and partial solid nodules, reduce the incidence of missed cancer, and shorten the reporting time of radiologists.This device can also assist in segmentation and accurate measurement of size after the detection of a pulmonary nodule.In addition, these techniques have been shown to assist in risk stratification of lung nodules, distinguish between benign and malignant nodules, and reduce unnecessary screening for lung cancer screening populations.LDCT Screening Guidelines for Lung Cancer in China 01 High-risk population selection This guide recommends that individuals who participate in annual LDCT screening be smokers between the ages of 50 and 74, have at least 20 packs/year of smoking history, and quit smoking if they have quit smokingThe time must not exceed 5 years.If there are other important risk factors for lung cancer in some high-incidence areas, it can also be used as a condition for screening high-risk groups. For example, the number of years of coal burning in Xuanwei without ventilation or poor ventilation is ≥15 years; the old project points have pits of 10 years or longer.History of operations or smelting.LDCT screening is not recommended for individuals with a history of cancer in the past 5 years (excluding non-melanotic skin cancer, cervical carcinoma in situ, and localized prostate cancer), inability to tolerate possible lung cancer resection, or in individuals with severe life-threatening conditions.02 Definition of positive nodules The nodules found by low-dose spiral CT screening can be divided into two categories: 1 affirmative benign nodules or calcified nodules; 2 uncertain nodules or non-calcified nodules, such nodulesThe follow-up principle was determined according to the nature and size of the nodules, and whether clinical intervention was performed based on the growth characteristics of the nodules during follow-up.Baseline screening: if the solid nodules or partial solid nodules are ≥5 mm in diameter, or the non-solid nodule diameter is ≥8 mm, or a suspicious lesion of the trachea or/and bronchus is found, or a lung diagnosed with low-dose spiral CTA single, multiple nodule, or lung cancer mass should be defined as positive if it should enter the clinical treatment program.• Annual screening for management of baseline nodules: a new non-calcified nodule or airway lesion, or an increase in the original nodule or an increase in solid composition is defined as positive.Management of annual screening nodules 03 Clinical intervention 1 Low-dose spiral CT examination found that airway lesions should be performed by fiberoptic bronchoscopy.For patients who are positive for fiberoptic bronchoscopy and suitable for surgical treatment, multidisciplinary treatment based on surgery should be performed.If the fiberoptic bronchoscopy is negative, it will go to the next year’s LDCT review, or LDCT review or fiberoptic bronchoscopy after 3 months and 6 months according to different conditions.2 Low-dose spiral CT diagnosis of lung cancer or highly suspected lung cancer? Low-dose spiral CT screening for highly suspected lung-positive lung nodules should be performed by high-grade thoracic surgery, oncology, respiratory and imaging medicineThe physicians collectively consulted to determine whether clinical treatment is needed and what method is used for treatment.For those who are suitable for surgical treatment, surgical treatment is preferred..
Low-dose spiral CT diagnosis of single lung, multiple nodules or lung cancer mass in lung cancer should be entered into the clinical treatment program, and the patients who are suitable for surgical treatment after clinical examination should be treated with multidisciplinary treatment.Low-dose spiral CT is diagnosed as lung cancer or a single, multiple nodule or lung mass in the lungs that is highly suspected of lung cancer. Due to the tumor, the patient’s cardiopulmonary dysfunction cannot tolerate surgery, or the patient is unwilling to undergo surgery.In the surgical treatment, the percutaneous lung biopsy specimens for the purpose of definitive lesions were sent to pathological examination and lung cancer driving gene detection.Chemotherapy-based multidisciplinary treatment should be given for the diagnosis of lung cancer by percutaneous lung biopsy. , please do not reprint without the authorization of the copyright owner.


The author ouyangshaoxia