Characteristics of Singapore lung cancer patients who miss out on lung cancer screening recommendations.

Introduction: The National Lung Screening Trial (NLST) identified individuals at high risk for lung cancer and showed that serial low-dose helical computed tomography could identify lung cancer at an earlier stage, leading to mortality reduction. However, there is little evidence regarding the effectiveness of the NLST criteria for the Asian population.
Methods: We performed a retrospective audit in our hospital from January 2018 to December 2018, with the aim to describe the characteristics of patients diagnosed with lung cancer and to identify patients who would miss out on lung cancer screening when the NLST criteria was applied.
Results: We found that only 38.1% of our cohort who were diagnosed with lung cancer met the NLST criteria strictly by age and smoking status. Patients who met the screening criteria would have derived significant benefits from it, as 85.4% of our patients had presented at an advanced stage and 54.6% died within 1 year. When the United States Preventive Services Task Force criteria was applied, it increased the sensitivity of lung cancer diagnosis to 58.7%. Only 15.5% of the female patients with lung cancer met the NLST criteria; their low smoking quantity was a significant contributing factor for exclusion.
Conclusion: The majority of Singapore patients diagnosed with lung cancer, especially females, would not have been identified with the NLST criteria. However, those who met the inclusion criteria would have benefited greatly from screening. Extending the screening age upper limit may yield benefits and improved sensitivity in the Singapore context.
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