Lung cancer screening programmes: Not "one size fits all". The need for personalized approach

Introduction: Early detection of lung cancer reduces mortality. Clinical trials have demonstrated lower lung cancer-related mortality in patients screened with low-dose CT. Evidence has led to a consensus and the design of screening programmes. However, uncertainty remains about many features that might be crucial like risk models for patient selection and risk stratification in order to increase efficiency of screening programmes. Aim: The aim of this study is to put the evidence for personalized screening strategies and the insertion of more risk factors in screening programmes. Methods: 860 lung cancer patients diagnosed though bronchoscopy in our hospital during 2023 & 2024 were included. 96 never smokers, 538 smokers and 226 ex-smokers. Data from patients files were used. Questions were posed through a phone call in never smokers and ex-smokers about second-hand smoke exposure, family history of cancer, out-house and in-house hazardous exposure. Results: In never smokers percentage of women was statistically significant higher than that of men. Ex-smokers were statistically significant older compared to smokers and never smokers. While in the total sample of patients only the 4,9% was <50 years old, percentage raises to 10,5% in never smokers. Moreover, 75% of never smokers reported second-hand smoke exposure. The exposure to second-hand smoke was statistically significant higher to women never smokers compared to men never smokers. Conclusion: Sex and second-hand smoke exposure represent risk factors that should be implemented in personalized lung cancer screening programmes. When more than one risk factor is present an earlier implementation of LD-CT would be appropriate.