Biomarkers as a tool to reduce disparities in lung cancer screening and detection

We thank Pura-Bryant et al. for their recent commentary on our narrative review summarising biomarkers of lung cancer with applications in lung cancer screening (LCS) and in never-smokers (1,2). We appreciate in particular the point they raised on the impact that biomarkers of lung cancer will have on individuals who face disparities in LCS.

Pura-Bryant et al. importantly highlight the work of Raman et al., which discusses ethnic minorities experiencing a higher risk and higher rates of lung cancer in the US. Disparities in healthcare, including participation in clinical trials, can contribute significantly to the health inequities experienced by minority populations such as ethnic groups (3). When considering women who have never smoked, for instance, Asian women experience a disproportionately increased risk of lung cancer compared to other ethnicities. Biomarkers meant for universal application must be able to account or adjust for such variations.

Thus, risk model-based screening that takes into consideration such factors can improve screening performance and additionally decrease ethnic disparities when compared to strategies solely dependent on age and smoking history (4). Complementing this advancement, artificial intelligence (AI)-driven personalised screening provides a targeted approach to lung cancer detection, which is especially advantageous for minority populations, including never-smokers. Through analyses of an individual’s genetics, lifestyle, occupational history and medical background, AI can generate a comprehensive risk profile and recognise diverse genetic susceptibilities and environmental exposures prevalent among different groups (5). Furthermore, socioeconomic factors can also be considered to ensure that screening plans align not only with medical appropriateness, but also feasibility and accessibility for individuals from various backgrounds (6). Tailoring the risk model to the specific needs and preferences of minorities addresses potential disparities in health assessment and well-informed decision making. Nevertheless, it constitutes only a partial solution.

Biomarkers that have the potential to replace traditional lung screening methods (i.e., agnostic to an individual’s characteristics) on the other hand may overcome issues related to phenotypes, such as smoking status and ethnicity. Platforms such as multi-cancer early detection (MCED) tests that screen patients for tumour determined biomarkers may have universal screening utility. For example, CancerSEEK employed a multianalyte blood-based MCED test that distinguished patients with eight common cancer types from healthy controls with high sensitivity (70%) and specificity (>99%) (7). MCED tests pose an attractive alternative to single-cancer screening tests, especially in low- and middle-income countries due to increased rates of cancer but decreased access to screening infrastructure.

It is important that we continue acknowledge those facing disparities in LCS and care, and continue to work towards achieving equity in LCS and research. While valuable progress has been made in recent years, we must ensure ample representation of ethnically diverse populations in biomarker research to ensure those at a higher risk of developing lung cancer are recognised. Finally, accessibility to screening initiatives should remain at the forefront of our considerations to ensure socioeconomically disadvantaged people also have access to lung and other cancer screening where available.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Translational Lung Cancer Research. The article did not undergo external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2023-5/coif). K.M.F. serves as an unpaid editorial board member of Translational Lung Cancer Research from August 2023 to July 2025. K.M.F. has received competitive Research Grant Funding from MRFF and NHMRC in the past 36 months, honoraria or royalties from UpToDate and Cochrane Clinical Answers, travel support funding from WCLC, ATS, and PCCP; and in-kind equipment funding from Olympus and Mevis Veolity. K.M.F. is the Former President of the Asia Pacific Society of Respirology. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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