Editor’s Note: The 2024 CACA Integrated Lung Cancer Conference, hosted by the Chinese Anti-Cancer Association, was held in Zhuhai from October 25 to 26. Focusing on the theme “Gathering Strength, Leading the Future,” the conference brought together prominent experts in the field of lung cancer to discuss critical issues and advancements. Oncology frontier interviewed Dr. Weimin Li from West China Hospital, Sichuan University, who shared insights on the progress and future outlook of precision lung cancer screening in China.

Oncology frontier: For years, efforts globally have focused on early detection and treatment of lung cancer to reduce mortality. Identifying clinically significant lung nodules while avoiding overtreatment remains a critical challenge. Could you start by describing the current state of lung cancer screening in China and unmet clinical needs?

Dr. Weimin Li: Studies have shown that low-dose spiral CT (LDCT) screening can reduce lung cancer mortality by 20%, making it a standard tool worldwide. However, screening in China faces several challenges.

First, identifying high-risk groups for screening is complex. In Western countries, heavy smokers over the age of 55 are considered high-risk, while in China, guidelines generally recommend screening for heavy smokers aged 50 and above. However, real-world studies show that lung cancer is increasingly affecting younger and non-smoking populations in China, unlike in the West, where 85% of lung cancer patients have a smoking history. Therefore, we need criteria tailored to the Chinese population. Many experts, including our team, recommend that individuals over 40 with at least one risk factor—such as smoking, occupational exposure, a history of cancer, family history of lung cancer or other cancers, or chronic respiratory disease—should undergo LDCT screening.

Second, accessibility to screening remains an issue, especially in rural and western regions. Developing mobile CT units suited to these remote areas is essential to improve screening availability.

Lastly, cost is a concern. I suggest covering screening costs through “basic medical insurance + commercial health insurance” to ease the financial burden on the public and make screening accessible to more high-risk individuals.

Oncology frontier: Recently, your team published research in Nature Medicine on a data-driven approach to risk stratification and precise management of lung nodules. Could you tell us more about this study’s key findings and its clinical significance?

Dr. Weimin Li: LDCT has proven effective for lung cancer screening, but 60-70% of screened individuals present with lung nodules. Distinguishing benign from malignant nodules, especially those likely to develop into cancer, remains challenging. On one hand, finding nodules can cause significant psychological stress, leading to unnecessary consultations and burdening both the public and medical resources. On the other, a missed early diagnosis may lead to disease progression, underscoring the importance of accurately assessing nodule malignancy for informed treatment and management.

Our study involved 120,000 participants from West China Hospital and its network, with 45,064 cases used as a training and internal test set, and 14,437 cases from a community screening cohort as an external test set. We developed the China Lung Nodule Reporting and Data System (C-Lung-RADS), a data-driven risk assessment model tailored to the Chinese population using artificial intelligence (AI). This model accurately assesses the benign or malignant nature of nodules in screened individuals, helping reduce psychological stress, prevent misdiagnosis or unnecessary biopsies, and improve the quality of lung cancer screening. Our goal is to ensure that early-stage lung cancer patients receive timely, accurate treatment, ultimately improving the 5-year survival rate for lung cancer in China.

Oncology frontier: Looking to the future, what areas do you believe warrant further exploration to improve the efficiency and accuracy of lung cancer screening?

Dr. Weimin Li: While we have developed a risk stratification standard for lung nodules suited to the Chinese population, continued innovation is needed to expand applicability. To further advance screening accessibility, especially in rural regions, we must focus on making screening more cost-effective and addressing LDCT radiation exposure. Potential solutions include a tiered lung cancer screening strategy, where low-risk individuals can be screened at community facilities while high-risk individuals undergo LDCT screening. Integrating molecular biomarker screening with LDCT could also aid in achieving precision diagnosis and treatment of lung cancer.

Dr. Weimin Li

• Director, Respiratory and Co-morbidity Research Institute, West China Hospital, Sichuan University
• Distinguished Changjiang Scholar, Ministry of Education
• Head, National Key Laboratory for Respiratory Diseases (West China)
• Vice President, Chinese Medical Association
• Vice President, Chinese Medical Doctor Association
• Vice Chairman, Respiratory Disease Committee, Chinese Medical Association
• With over 200 research papers published in Cell, Nature Medicine, and other journals, his research earned him a National Science and Technology Progress Award (Second Prize) as the primary investigator.