Brief Report: Translating Selection Criteria for Lung Cancer Screening to an Indian Context-An Analysis From a Tertiary Health Centre.

Background: Lung cancer is the most common cause of cancer in India, leading to growing interest in the potential for screening. Established lung cancer screening programs exist in both the U.K. and U.S. contexts, using either combinations of risk factors (United States) or risk models (United Kingdom) to determine eligibility. Whether these approaches can be directly translated to an Indian context to determine eligibility for lung cancer remains unknown. Methods: We analyzed a case series of individuals newly diagnosed or under active follow-up for lung cancer at a large tertiary referral center in northern India. We considered eligibility for lung cancer on the basis of the US Preventive Services Taskforce 2021 criteria, and predicted risk using the lung cancer incidence (UCL-I), the lung cancer discrimination (UCL-D), the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial modified 2012 lung cancer risk prediction (PLCOm2012), and Liverpool Lung Project (LLP) models. Results: A total of 472 people with lung cancer were included. The median age at diagnosis of lung cancer was 60 years, and 83.7% of the cohort were men. Most were never- (30.5%) or former (47.3%) smokers. 97% of lung cancers were diagnosed at stages III or IV. Nearly half of the individuals were under the age of 55 or were never-smokers and so would not have been considered for risk assessment under U.K. screening criteria. Fewer than 40% of ever-smokers would have met thresholds for lung cancer screening used in the United States or the United Kingdom. Conclusion: Criteria used to determine eligibility for lung cancer screening in the U.K. and U.S. settings are unlikely to be translatable to an Indian context without modification. Prospective screening studies should be considered before widespread implementation in India.