The Risk of Lung Cancer in Nonsmokers: To Screen or Not to screen?

Authors

Sharon L. Coote-Johnson, University of LynchburgFollow

Specialty

Pulmonary

Advisor

Bernard Toney Jr., DMSc, PA-C

Abstract

ABSTRACT

Purpose: This article aims to determine the need for Lung Cancer screening of non-smokers and never smokers to improve morbidity and mortality of those at risk.

Method: A PubMed literature search was conducted with the search terms Lung Cancer Screening in non-smokers. Thirty pertinent articles were retrieved and served as the basis for this clinical review.

Results: There is a lack of evidence-based research to demonstrate positive or negative aspects of screening patients who have never smoked but may have other risk factors for lung cancer.

Conclusion: In the United States, about 10 to 20 percent of lung cancers, or 20,000 to 40,000 of lung cancers each year, happen in people who never smoked or smoked fewer than 100 cigarettes in their lifetime. ¹ The United States Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults 50 to 80 years of age who have a 20-pack-year smoking history and currently smoke or have quit within the past 15 years. ² Risk-based lung cancer screening is an alternative approach that defines screening eligibility based on an individual’s personal risk. ³ The selection of individuals for lung cancer screening based on their risk has been shown to improve the sensitivity and specificity associated with the screening program's eligibility criteria compared to the USPSTF criteria. ³

Keywords: Lung Cancer Screening, Non-Smoker, never smokers, Risk factors

SIGNIFICANCE OF LUNG CANCER SCREENING IN NON-SMOKERS

Due to the COVID-19 pandemic, more people have sought medical attention for chest complaints who would not have otherwise been screened. With the increase of individuals seen in the emergency rooms with respiratory complaints, there has been an increase in incidental nodules found in smokers and non-smokers on various types of chest imaging. Due to the incidentally found nodules, more non-smokers who would not have typically been screened have been noted to have high-risk lung nodules. The USPSTF Lung Cancer screening guidelines do not consider the 20,000 to 40,000 non-smokers in the United States diagnosed with Lung Cancer annually. For this reason, tailoring screening decisions to the individual by incorporating patients' personal history and risk stratification into the screening process could improve lung cancer screening effectiveness and cost-effectiveness and deliver personalized screening schedules. Therefore, screening programs that provide customized screening schedules are needed.

TARGET AUDIENCE The target audience for this proposal will be all primary care and pulmonary care healthcare providers. However, patients and their families may also benefit from this article.

PURPOSE This proposal will enlighten the audience about the risks of developing lung cancer in non-smokers and never smokers. In the United States, about 10 to 20 percent of lung cancers, or 20,000 to 40,000 lung cancers each year, happen in people who never smoked or smoked fewer than 100 cigarettes in their lifetime.² Researchers estimate that secondhand smoke contributes to about 7,300 and radon about 2,900 of these lung cancers. Lung cancer is the leading cause of cancer death worldwide and the third most common cancer in the United States.² Lung Cancer is the most preventable cancer in the world. Patients should be screened for lung cancer based on specific risk stratification criteria.

TARGET JOURNAL FOR SUBMISSION I plan to submit my scholarly topic article to the Federal Practitioner Journal. “Federal Practitioner is a peer-review journal for health care professionals of the Department of Veterans Affairs, Department of Defense, and Public Health Service.” “Federal Practitioner is a monthly peer-reviewed clinical journal serving more than 35,700 physicians, clinical pharmacists, physician assistants, advanced practice nurses, and medical center administrators working within the Department of Veterans Affairs, the Department of Defense, and the Public Health Service.”⁴The target audience consists of VA, DOD, and PHS medical professionals. Many of our retired and active-duty members have had various exposures in their military career that increase their risk of Lung Cancer; therefore, the Federal Practitioner Journal is appropriate to publish this article. VA and DoD also often receive funding for research studies and have been at the forefront of many medical advances. “The mission of the Federal Practitioner is to educate federal health care providers (HCPs) and provide a forum for sharing healthcare-related studies, best practices, guidelines, program profiles, and case studies.”⁴

An internal team reviews manuscripts submitted to Federal Practitioner for pre-peer review. The manuscripts are checked by at least two peer review committee members. Peer reviews are conducted double-blindly. They are reviewed on importance, accuracy, relevance, clarity, timeliness, balance, and reference citation. Physician assistants can be the primary authors in this journal. Federal Practitioner has never published an article on Lung Cancer Screening in non-smokers.⁴

I have reviewed the submission requirements and topic to present. The journal's formatting requires Times New Roman font, 12-point, double-spaced, and left-aligned. I plan to submit a feature article with a required word count of ≤ 4000 words, excluding references, four or fewer tables or figures, and <100 references. “The required order by the journal is: title, enter keywords, and select classifications (subject areas discussed in the manuscript).”⁴ Authors must attach the following submission components:1) Cover page; 2) Manuscript (without author information), tables, figures; and 3) All authors must complete the forms and include them in the Editorial Manager submission using the Attach Files page during the manuscript submission disclosure checklist. The Federal Practitioner requires its authors to format their references according to the AMA Manual of Style (2020). The author guidelines can be accessed at: https://www.mdedge.com/fedprac/page/submission-guidelines.⁴

ARTICLE TYPE I plan to submit a clinical review article on the need to develop a more personalized screening test for lung cancer. The word count for clinical review articles is ≤ 4000 words, excluding references, four or fewer tables or figures, and <100 references. ⁴

The proposed structure for the journal article is as follows:

ABSTRACT

• Keywords: Lung Cancer screening, non-smoker, never smokers

INTRODUCTION

• Keywords: Lung Cancer screening, risk factors, non-smoker, never smoker

DISCUSSION

• Lung Cancer Screening: Importance in non-smokers and never smokers
  • United States Preventive Services Task Force (USPSTF), Low dose computed tomography (LDCT), smoking pack-years
• Types of Cancer: Adenocarcinoma, Squamous cell cancer, small cell cancer
• Treatment: genetic mutations, biomarkers, EGFR, ALK

KEY POINTS

The key points of this project are as follows:

1. To educate the target audience about the incidence of lung cancer in individuals who have never smoked.
2. To educate the target audience that the current lung cancer screening guidelines exclude non-smokers and never smokers.
3. To educate the target audience on the need to develop a more personalized screening test for Lung Cancer.
4. To provide the audience with an understanding of various risk stratification models that could be used to diagnose lung cancer in non-smokers and never smokers.
5. To improve patient care in the early diagnosis and treatment of lung cancer in non-smokers and never smokers.

CONCLUSION

Lung Cancer in non-smokers is underrecognized. Both clinicians and policymakers need to study risk factors besides age and tobacco use to understand the incidence and prevalence of lung cancer in this population. Various risk prediction models for lung cancer screening have been developed in recent years, and there is evidence supporting their superiority against the current USPSTF recommendations. ⁵A screening programs incorporating risk prediction models can prevent more lung cancer deaths and minimize unnecessary invasive follow-up exams, thus improving the efficiency and cost-effectiveness of lung cancer screening. There is a need for optimizing detection strategies that can provide opportunities for early detection and intervention for lung cancer in the high-risk non-smoking population.⁵

REFERENCES

1. Lung Cancer Among People Who Never Smoked | CDC. Published October 19, 2021. Accessed February 22, 2022. https://www.cdc.gov/cancer/lung/nonsmokers/index.htm

2. Dubin S, Griffin D. Lung Cancer in Non-Smokers. Mo Med. 2020;117(4):375-379. Accessed February 22, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431055/

3. Who Should Be Screened for Lung Cancer? | CDC. Published December 17, 2021. Accessed February 27, 2022. https://www.cdc.gov/cancer/lung/basic_info/screening.htm

4. Submission Guidelines. Accessed June 10, 2022. https://www.mdedge.com/content/submission-guidelines-1

5. Lung Cancer Among People Who Never Smoked | CDC. Published October 19, 2021. Accessed February 22, 2022. https://www.cdc.gov/cancer/lung/nonsmokers/index.htm

Recommended Citation

Coote-Johnson SL. The Risk of Lung Cancer in Nonsmokers: To Screen or Not to screen?. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2023; 5(1).