Korean Lung Cancer Screening Project
Korean Lung Cancer Screening Project
Lung cancer is by far the leading cause of cancer death and has a lower relative survival
 rate than other types of cancer because most lung cancers are detected at an advanced stage
 when they are first diagnosed.

 Recently, a randomized control trial suggests that low-dose computed tomography (LDCT)
 enables an early stage detection and it has been increasingly accepted as an efficient
 screening method for high-risk individuals to reduce lung cancer mortality.

 In 2011, The National Lung Screening Trial (NLST) in the U.S. has produced results that
 screening high-risk smoking groups (who have at least 30 pack-year smoking history and
 currently smoke or have quit within the past 15 years) aged 55 to 74 years with LDCT reduced
 lung cancer mortality by 20%.

 Based on the evidence, Korean National Cancer Center has developed and published the
 guideline of lung cancer screening using LDCT for high-risk populations in 2015. The
 guideline recommends annual LDCT screening for high-risk smoking groups aged 55 to 74 years,
 with at least 30 pack-year smoking history and current smokers or past smokers who quit
 smoking within 15 years.

 The Korean Lung Cancer Screening project (K-LUCAS), a nationwide, multicenter, prospective
 study started to evaluate the effectiveness and feasibility of lung cancer screening with
 LDCT for considering implementation of a national lung cancer screening program in Korea.
◎ Objective

 This study is to evaluate the effectiveness and feasibility of lung cancer screening with
 LDCT for considering implementation of a national Lung Cancer Screening Program in Korea.

 ◎ Recruiting procedure

 K-LUCAS involves 14 general hospitals located nationwide. The participants in K-LUCAS are
 recruited from the visitors in these hospitals for receiving national cancer screenings or
 smoking cessation services. The candidates are evaluated based on the questionnaire that is
 completed in prior to the national cancer screenings or smoking cessation services.
 Invitations will be sent to those candidates who meet our selection criteria to take part in
 LDCT lung cancer screening. Advertising to public including the information both of screening
 benefit and harm will be held in hospitals, newspaper, local bus stations and subways.

 In addition to the criteria-based participant selection, a lung cancer risk prediction model
 will be adopted to improve the effectiveness of participant selection. The lung cancer risk
 prediction model considers various lung cancer risk factors in addition to age, smoking
 history and smoking quit duration which are already examined in the inclusion criteria. The
 model evaluates drinking amount, physical activity, family history of cancer, past history of
 lung disease and so on, in participant selection.

 ◎ Screening procedure

 If the candidate meets the selection criteria or is approved by risk prediction model,
 investigators carefully explain the benefits or harms of the LDCT screening and offer them to
 participate in a LDCT lung cancer screening. If the candidate agrees on screening
 participation, an informed consent form is obtained and LDCT screening date is scheduled and
 confirmed. K-LUCAS also provides a smoking cessation counselling to current smokers on
 revisiting for the result counselling. A follow-up call is made after 6 months from the LDCT
 screening in order to assess smoking cessation status following LDCT screening.

 ◎Reporting LDCT results

 The LDCT screening results are evaluated by radiologists in accordance with Lung imaging
 reporting and data system (Lung-RADS).

 Network-based computer-aided detection (CAD) system will be used in K-LUCAS to assist
 reducing diagnostic errors and increasing lung nodule detection sensitivity.
We select participants based on the following criteria.

 -  Inclusion Criteria (1)

 -  Age : 55-74 years old

 -  Smoking history of at least 30 pack-years

 1. current smokers

 2. past smokers who quit smoking within 15 years

 -  Inclusion Criteria (2) The lung cancer risk prediction model considers various lung
 risk factors in addition to age, smoking history and smoking quit duration. This
 includes drinking amount, physical activity, family history of cancer, information on
 lung disease and so on, in participant selection. Following criteria is applied when
 the lung cancer risk prediction model is used for participant selection.

 -  Age : 50-74 years old

 -  Smoking history of at least 20 pack-years

 1. current smokers

 2. past smokers who quit smoking within 15 years

 -  Exclusion Criteria:

 -  Lung cancer diagnosed and treated

 -  Inability to move without help (ECOG status 2 or higher)

 -  Have been treating regularly for tuberculosis, pneumonia and interstitial lung
 disease

 -  Treated for any cancer within the last 5 years (*Exception: Thyroid cancer, Skin
 cancer)

 -  A chest CT examination less than 6 months