title: Assessment of Selection Criteria for Low-Dose Lung Screening CT Among Asian Ethnic Groups in Taiwan: From Mass Screening to Specific Risk-Based Screening for Non-Smoker Lung Cancer.
abstract: The National Lung Screening Trial (NLST) showed low-dose screening chest computed tomography (CT) reduced the lung cancer mortality rate up to 20% in high-risk patients in the United States. We aimed to investigate the impact of applying the NLST eligibility criteria to the population in Taiwan, and to identify additional risk factors to select subjects at risk for lung cancer.
  
  
  
  We retrospectively reviewed the medical records of 1763 asymptomatic healthy subjects (age range, 40-80 years) who voluntarily underwent low-dose chest CT (1029 male, 734 female) from August 2013 to August 2014. Clinical information and nodule characteristics were recorded. The results of subsequent follow-up and outcome were also recorded.
  
  
  
  A total of 8.4% (148/1763) of subjects would have been eligible for lung cancer screening based on the NLST criteria. However, only 1 of these eligible subjects would have a lung cancer detected at baseline. Among the 1615 subjects who did not meet the NLST criteria, the detection rates of lung cancer were 2.6% in women and 0.56% in men. Logistic regression showed that female gender and a family history of lung cancer were the 2 most important predictors of lung cancer in Taiwan (odds ratio, 6.367; P = .003; odds ratio, 3.017; P = .016, respectively).
  
  
  
  In conclusion, NLST eligibility criteria may not be effective in screening for lung cancer in Taiwan. A risk-based prediction model based on the family history of lung cancer and female gender can potentially improve the efficiency of lung cancer screening programs in Taiwan.
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Fu-Zong
authors.initials: FZ
authors.lastname: Wu
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Yi-Luan
authors.initials: YL
authors.lastname: Huang
authors.affiliation: Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Carol C
authors.initials: CC
authors.lastname: Wu
authors.affiliation: Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: En-Kuei
authors.initials: EK
authors.lastname: Tang
authors.affiliation: Physical Examination Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; College of Health and Nursing, Meiho University, Pingtung, Taiwan.
authors.forename: Chi-Shen
authors.initials: CS
authors.lastname: Chen
authors.affiliation: Physical Examination Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; College of Health and Nursing, Meiho University, Pingtung, Taiwan.
authors.forename: Guang-Yuan
authors.initials: GY
authors.lastname: Mar
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Yen
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan. Electronic address: wu.mingting@gmail.com.
authors.forename: Ming-Ting
authors.initials: MT
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000379:methods; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking; D013624:Taiwan / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Adenocarcinoma; Lung cancer; Lung-RADS; Screening criteria; Smoking