Jianwei Wang – Professor and Chief Physician, Department of Diagnostic Imaging, Cancer Hospital, Chinese Academy of Medical Sciences. Prof. Wang Jianwei is a core member of the lung cancer screening team at the hospital. After receiving his PhD from Peking Union Medical College, he conducted postdoctoral research at I-ELCAP, the world’s first systematic LDCT lung cancer screening, under the supervision of Dr. Claudia I. Henshcke, who is well known in the field of lung cancer screening. After returning to China, she continued her work in lung cancer screening in China, and every year, she conducted international exchanges on lung cancer screening and received full recognition. Lung cancer is the malignant tumor with the highest incidence and mortality rate worldwide and the greatest threat to the health and lives of the population. About two-thirds of patients have regional or distant metastases by the time they are diagnosed, and the five-year survival rate is only 15%. Currently, the only method to reduce the death rate of lung cancer is low-dose CT (LDCT) screening, and Cancer Hospital of Chinese Academy of Medical Sciences is the first medical institution to carry out lung cancer screening in China, and has completed more than 18,000 lung cancer screenings since 2005. ”Leading” Lung Cancer Screening As we all know, if lung cancer can be surgically removed at an early stage (especially stage I), the prognosis will be significantly improved. Although X-ray chest X-ray can detect more lung cancers and improve the surgical resection rate, it does not reduce the death rate of lung cancer, so it is not recommended as a screening tool for lung cancer. Since the 1990s, with the development of spiral CT technology, lung cancer screening research has entered the era of LDCT, and has become a hot spot in lung cancer research in the past 20 years. In 2005, the LDCT lung cancer screening team led by Prof. Wu Ning from the Department of Diagnostic Imaging of Cancer Hospital of Chinese Academy of Medical Sciences started the first case of lung cancer screening. 2008, the team started to cooperate fully with the International Early Lung Cancer Action Program (I-ELCAP), as As a member of I-ELCAP, the team conducts standardized LDCT lung cancer screening of healthy people according to the screening protocol of I-ELCAP and in accordance with the national conditions of China. The team has also joined hands with the Cancer Prevention Department of the hospital to conduct lung cancer screening for the healthy population in Beijing. So far, more than 18,000 screenings have been completed and more than 40 patients with early stage lung cancer have been detected, 80% of whom are stage I. The Cancer Hospital of the Academy of Medical Sciences is the first medical institution in China to conduct population-based and systematic lung cancer screening. Today, the LDCT lung cancer screening team of the hospital has formed a professional team of about 20 people, and has accumulated rich experience in lung cancer screening, and its research results have been published in domestic core journals. The team has expanded the screening target to the healthy population of society and created a series of norms and standards suitable for China’s national conditions, and its pioneering work has brought more hope to lung cancer patients in China. Screening must be standardized In recent years, more and more medical institutions in China have carried out or intend to carry out LDCT lung cancer screening, but there is still a big gap compared with developed countries, and there is a big difference in the understanding and treatment level of lung cancer screening among medical institutions, and there are many irregularities in clinical practice, so we should pay great attention to the qualification of screening institutions, the selection of screening targets, and the implementation of screening programs. Who should be screened? Who should be screened? The LDCT lung cancer screening program is a complex, long-term and systematic project. In addition to the necessary hardware conditions such as spiral CT machines, there should be sufficient lung cancer professionals and other software conditions to carry out the screening work. As the International Association for the Study of Lung Cancer (IASLC) pointed out in its statement on lung cancer screening, a key factor in the implementation of future screening programs is the need for a well-trained team of multidisciplinary experts in lung cancer-related fields. In this team, not only chest radiologists experienced in diagnostic imaging, but also multidisciplinary specialists in thoracic surgery, oncology, pathology, and respiratory medicine should be actively involved in the collaboration, and thoracic surgeons should minimize surgical risks, such as actively performing thoracoscopic surgery. Therefore, medical institutions with multidisciplinary collaboration capability should be actively encouraged to carry out LDCT lung cancer screening, and only such institutions are likely to provide high-quality screening and follow-up services to the examinees. Who should be screened? Reasonable and accurate selection of screening subjects can reduce the proportion of ineffective screening and improve the health economics benefits of lung cancer screening. Several foreign screening guidelines have selected high-risk groups as screening targets, but the definition of high-risk groups varies among guidelines. Increasing age and cumulative tobacco exposure are the two most important risk factors for lung cancer. Other risk factors include chronic lung disease (chronic obstructive pulmonary disease, pulmonary fibrosis), environmental or occupational exposure, radon exposure, previous cancer, radiation therapy received, and family history. Some foreign studies have also used lung cancer risk prediction models to screen high-risk groups. The risk factors for lung cancer in China are different from those in western developed countries, and factors such as passive smoking, air pollution and kitchen fumes need to be taken seriously. How to screen? Researchers should strive to improve their knowledge and application of various lung cancer screening guidelines or expert consensus at home and abroad, and follow them to conduct screening in a standardized manner. In particular, radiologists should have rich experience in diagnostic chest imaging, preferably with relevant training before engaging in lung cancer screening, and be able to accurately judge the nature of lung nodules detected by LDCT, provide reasonable management measures, frequency and duration of follow-up according to the different characteristics of lung nodules, and ensure that interventions on benign lung lesions are minimized. The aim is to ensure that interventions for benign lung lesions are minimized. LDCT lung cancer screening is a systematic work, from the collection of information from screeners, standardized CT techniques, reasonable screening protocols, to the final recommendation to screeners, each step of the process has strict and standardized management, including the feedback of screening recommendations to patients also involves the issue of communication skills, which should neither cause excessive stress to patients nor make them blindly feel that there is no problem. The patient should not be overly stressed nor blinded to the fact that there is no problem. Happily, with the joint efforts of several experts from the Cardiothoracic Group of the Radiology Branch of the Chinese Medical Association, China’s first “Expert Consensus on Low-Dose Spiral CT Lung Cancer Screening” was published in May this year, so that lung cancer screening in China can be regulated from now on. In addition, not all doctors in radiology can do lung cancer screening. Before engaging in LDCT lung cancer screening, they must undergo six months to one year of specialized screening training and complete a certain number of cases every day. Because screening is aimed at healthy people, the consequences of a missed diagnosis can be very serious. However, at the same time, over-diagnosis cannot be done, which will bring excessive psychological pressure to patients and their families, and this proportion must be strictly regulated. The priority group for lung cancer screening is those between 45-70 years old, who are also the backbone of society. Therefore, lung cancer screening is a task that benefits the whole society and can also bring great social benefits. Professor Wang Jianwei expressed his hope that more time would be given to this work and to expand the scope of screening. The team is willing to provide theoretical and technical guidance to domestic institutions if they are willing to carry out lung cancer screening. From the latest international progress and development trend, LDCT lung cancer screening has moved from the research field to clinical application, which is expected to bring forward the tumor stage of lung cancer patients, and then drive lung cancer treatment into a new era. Faced with the severe situation that the prevalence and death rate of lung cancer continue to rise in China, domestic medical institutions with multidisciplinary collaboration should be encouraged to actively carry out LDCT lung cancer screening among high-risk groups of lung cancer, so as to promote the continuous advancement of lung cancer screening research and improvement of screening protocols in China, increase the early diagnosis rate of lung cancer in China, improve the current status of lung cancer treatment in China, and benefit more people.