We speak to Professor Pan-Chyr Yang, Chair Professor in the Department of Internal Medicine, National Taiwan University College of Medicine, and Academician, Academia Sinica, Taipei, Taiwan.
What is your role in lung cancer?
I am a pulmonary physician specializing in the diagnosis and treatment of pulmonary diseases and lung cancer. In addition to my daily clinical practice, I am actively involved in translational research focused on understanding the molecular causes of lung cancer in people with no history of smoking. I am particularly interested in studying the effectiveness of low-dose computed tomography (LDCT) for lung cancer screening in high-risk individuals.
I also hold the position of committee chair for the East Asia Lung Cancer Screening Consensus, where I work towards promoting lung cancer screening in the region. This involves collaborating with experts in the field to develop guidelines and recommendations for effective screening strategies.
Regarding lung cancer screening in Taiwan, what’s working well and what could be improved?
First, it is important to understand that in Taiwan, lung cancer is the leading cause of cancer-related deaths in both men and women. Surprisingly, a significant proportion of lung cancer patients, especially women, have no history of smoking – as many as 94% of female lung cancer patients. In our efforts to improve lung cancer care and reduce mortality rates, we are dedicated to developing strategies that expand the eligibility for lung cancer screening. Our goal is to ensure that both people with a history of smoking and those who have never smoked but are at risk of developing lung cancer have access to appropriate screening measures.
The real-world evidence has shown that LDCT can detect lung cancer at an earlier stage, thereby reducing mortality. In 2015, we initiated the Taiwan Lung Cancer Screening for Never-Smoker Trial (TALENT), which utilises LDCT for lung cancer screening in people with no history of smoking with other risk factors. In the first round of screening, the lung cancer detection rate was 2.65%, with 96.5% of confirmed cases being at stage 1. It is important to note that a family history of lung cancer can increase the risk of developing the disease.
Based on the promising results from the TALENT trial, we successfully persuaded the government to implement nationwide LDCT screening starting from 1 July 2022. The programme focuses on people with a smoking history of 30 pack-years and those with no history of smoking but with a family history of lung cancer. It has already been highly successful, with over 40,000 individuals screened until 31 May 2023, and around 400 cases of lung cancer detected (87% at stage 0-1). The nationwide screening programme aligns with the findings from the TALENT trial.
What do you hope the Lung Cancer Policy Network will achieve?
I am thrilled to be a part of the Network and seize the opportunity to exchange our experiences and insights with colleagues from all over the world. We believe that our experience can contribute to the advancement of lung cancer screening. It is crucial not only to target people with a history of smoking but also to explore the possibility of expanding the screening criteria to include people who have never smoked but who have risk factors, such as family history and exposure to hazardous materials. By undertaking this initiative, we can enhance lung cancer control and decrease mortality rates associated with the disease.
What would you like lung cancer care to look like in the future?
Personalised therapy for advanced lung cancer is the most successful example of precision medicine. We hope that in the near future, lung cancer prevention and early detection through LDCT can also be personalised and tailored to the different risks in individual people. Different strategies can be applied to prevention and early detection in those who have never smoked, and AI algorithms and radiomics can be developed to enhance current LDCT screening accuracy.
What do you like to do in your spare time, away from work?
I enjoy jogging.
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Learning from Taiwan: implementing a national lung cancer screening programme
We spoke with Network member Professor Pan-Chyr Yang, who shared his experience of setting up a national lung cancer screening programme in Taiwan.