SingapOre Lung Cancer Screening Through Integrating CT With Other biomarkErs (SOLSTICE)

This is a single arm cohort screening study. Briefly, this prospective study will involve screening the general population with risk factors for lung cancers with the aim of investigating the feasibility of implementing LDCT screening in the local context. Both smokers and non-smokers with the known risk factor of family history of lung cancer up to 2nd degree are eligible to participate in the study. Depending on emerging epidemiological data, additional high-risk cohorts may be included in this study. Subject demographics, smoking history, exposure to the aforementioned environmental factors, family history of lung cancer, history of tuberculosis and comorbidity will be captured in detail. The age range for inclusion is 55 to 74 years. Given the higher proportion of never-smoker lung cancer in Singapore, we aim to recruit 650 non-smoking and 350 smoking individuals for our study. LDCT scan results will be reported based on the Lung-RADS classification. Participants will be stratified into various Lung-RADS groups based on the CT appearance and size of nodules. An alphanumeric Lung-RADS score will be assigned to each subject which will guide the downstream management of screened participants. Participants with LDCT scan results of Lung-RADS score 2 and above will be referred to the nodule clinic under SingHealth DUKE-NUS Lung Centre for standardized follow-ups and/or diagnostic evaluation. These patients will undergo clinical surveillance (up to maximum of 5 years depending on their nodules) and will be managed as per current clinical practice. Participants with LDCT scan results of Lung-RADS score of 1 will undergo further screening surveillance which will end after 2 years if they have no nodules detected.