Should Nonsmokers Be Excluded from Early Lung Cancer Screening with Low-Dose Spiral Computed Tomography? Community-Based Practice in Shanghai1

OBJECTIVE: We investigated the efficacy of early lung cancer screening with low-dose spiral computed tomography(LDCT) in both smokers and nonsmokers based on the current situation of community health service, with integration of superior resources of medical institutions at all levels in Shanghai. METHODS: From August 2013 to August 2014, we screened 11,332 (male 7144; female 4188) high-risk individuals in selected communities of Minhang, Shanghai City, for early diagnosis of lung cancer with LDCT combined with multidisciplinary comprehensive treatment pattern including minimally invasive surgery, exploring the medical service network covering prevention, diagnosis, treatment, rehabilitation, and follow-up. RESULTS: Screening resulted in a diagnosis of cancer in 29 participants. Of these participants, 27 had primary lung cancer, 1 had lung metastatic cancer, and 1 had breast cancer. The detection rate of primary lung cancer was 238.26 cases per 100,000 person-years among all the participants. Specifically, the incidence of primary lung cancer was 336.97 cases per 100,000 person-years among the nonsmoking participants, as compared with 159.06 cases per 100,000 person-years among the smoking participants (P = .054). Among the 27 primary lung cancers, 22 (81.48%) had stage 0 to I lung cancer. CONCLUSION: Based on community health service, screening with LDCT could improve the early diagnosis rate of lung cancer in both smokers and nonsmokers with feasibility and validity, which could be applicable in qualified eligible medical centers and communities in China. It is not reasonable to exclude nonsmokers from screening with LDCT.