JULIA ROTOW: Current lung cancer screening guidelines, and here I'll cite the US Preventive Services Task Force guidelines recommend lung cancer screening for those at high risk as defined by cumulative years of tobacco use and age. So the current guidelines, which released in 2021, recommend screening for those 50 and older, technically 50 to age 80 with at least a 20 pack-year history of tobacco use. And that means either one pack of cigarettes per day for 20 years, two packs per day for 10 years, and so on.

And that's considered to be high risk, and they recommend an annual low-dose screening CT scan. We know that by doing this screening, we can reduce the risk of death from lung cancer by catching lung cancer early when it's more treatable. This improves survival.

Unfortunately, in this country, uptake of lung cancer screening has been very low. And in many studies, only 15% to 30% of people who are eligible for lung cancer screening actually have this done. And that's a real missed chance to catch lung cancers at an early stage particularly with all these different advances we're seeing improving outcomes for early stage lung cancer.



RAMI MANOCHAKIAN: My name is Dr. Rami Manochakian. I'm a thoracic medical oncologist and an associate professor of medicine at Mayo Clinic, Florida. We're here today at the ASCO Annual Meeting. That's the annual meeting for the American Society of Clinical Oncology, where new updates and advancements in cancer research and cancer treatments are presented annually.

I'm here to tell you today about a major clinical trials and study that the investigator of this study reported their results yesterday in what we call a plenary session, which is one of the major sessions of this conference. This study is about patients with early stage lung cancer in particularly, stage one to stage three, when the cancer is still curable.

It's about a patient population whose cancer has a special driver of the cancer. We call it a mutation, in particular, EGFR mutation. It's something that is believed to be the driver of the cancer growth. And for these patients, after they undergo surgery to take out their tumors, this study looked at giving these patients a targeted therapy, a drug that is called osimertinib, which is a drug that is already approved and used for patients who have advanced lung cancer with that mutation, but looked at giving it to them early if they have an early stage cancer and they undergo surgery to see if it could actually make a difference.

It's a large study that includes hundreds of patients. And this study tried to give these patients either this drug or a placebo for a period of three years to try to see if it makes a difference. The study results were reported actually a few years ago and it showed a difference. It showed a meaningful difference. It showed that it does delay the cancer from coming back after surgery.

However, yesterday the results were focusing on updated data about overall survival, which means did giving this drug make a difference as far as patients living longer? And indeed the study results were positive and exciting, and it did show that for patients who take this drug, when we look at all the statistics and the analysis, that these patients do better. And this drug is actually effective in prolonging life.



JULIA ROTOW: The first step is to speak with your primary care doctor. It's a great opportunity to have a conversation about whether lung cancer screening might be helpful for you as an individual. And our physicians really enjoy speaking with their patients about this to help reduce their risk, just as you might talk about colonoscopies, or mammograms, or prostate cancer screening.

Now, our current lung cancer screening guidelines don't catch everyone who might be high risk, and there are some abstracts and presentations at ASCO this year that are getting to that point. For example, we know there are racial and ethnic disparities in both access to lung cancer screening and eligibility for screening based on current guidelines. And there are ongoing efforts to try to offer more risk-adaptive scores or risk-adaptive strategies to try to understand a lung cancer risk.

I'd like to highlight a lung cancer screening study being presented at this year's ASCO being led by Dr. Elaine Shum at NYU. And this study looks at instituting lung cancer screening with three annual CT chest scans in young Asian women who never smoked. So starting at age 40, even younger than our standard guidelines, and in people who never smoked or very minimally smoked-- again, an unusual population for our wider national guidelines.

And this speaks to the high risk of lung cancer mortality and Asian-Americans. It's the leading cause of cancer death for this population. They have a higher rate of these actionable driver mutations, like EGFR in their cancers.

And at this ASCO, Dr. Shum will be presenting in an upcoming session some preliminary results from the first 200 patients who enrolled on the study. And here they found a 1.5% rate of lung cancer in this young, non-smoking patient population. And all of the lung cancers they identified were EGFR mutated and were able to go on to receive adjuvant EGFR-targeted therapy. So it speaks to the importance of not just thinking about our traditional high risk patient population, who should absolutely get 100% screening if we could achieve it, but also these other less-common patient populations who can still benefit from potential screening strategies.



JULIA ROTOW: EGFR is a protein that sits within tumor cells. It's called the epidermal growth factor. And when active, it tells cells to grow and divide. In lung cancer cells, that can be made abnormally active by having a mutation which causes it to turn on when it should not. And this, we know, helps to drive lung cancer formation and growth and survival. And this is by targeting EGFR with EGFR inhibitors, which can shut down that protein and stop that survival signal, can improve outcomes for patients with this subtype of lung cancer.

So for people diagnosed with an early stage lung cancer, so a lung cancer that might be able to be removed surgically with intent to cure, there are a number of different treatments that can be offered before or after surgery to try to reduce the risk of relapse and improve survival.

These include what's called neoadjuvant therapy, So presurgical therapy, usually chemotherapy or immunotherapy, for example, immune stimulating drugs; or adjutant therapy. And that's post-operative therapy, so therapy after recovery from surgery that is similarly meant to reduce risk of relapse in the future.