Overview
Lung cancer is a leading cause of cancer-related death in Kuwait, where most cases are diagnosed at an advanced stage and there is no national screening program. This prospective pilot feasibility study offers low-dose computed tomography (LDCT) screening to high-risk individuals aged 50-80 years (about 590 participants, so that about 500 complete a baseline scan), recruited by physicians at Ministry of Health polyclinics and hospital chest clinics and screened at the Chest Diseases Hospital. The primary objective is to assess the uptake of, and barriers to, LDCT lung cancer screening in Kuwait and to establish a framework for a national screening program. Participants undergo eligibility assessment (smoking history of at least 20 pack-years, totalled across all smoked tobacco products using pre-specified equivalency conversions for shisha/waterpipe, cigar, pipe, and roll-your-own tobacco), baseline assessment, and are offered three LDCT screening rounds (a baseline scan and two annual rounds) with Lung-RADS-based management and follow-up. Scans are read by radiologists without artificial intelligence (AI); at the end of the study, AI software is run once on the archived scans in a separate reader study. Findings will inform national lung cancer screening guidelines for Kuwait.
Description
Participants are recruited by physicians at Ministry of Health sites: at present eight designated polyclinics, where smoking-cessation sessions are the main recruitment channel, and the respiratory or chest clinics of five MOH hospitals; further polyclinics may be added. All screening is performed at the Chest Diseases Hospital. Each participant is offered three screening rounds (a baseline scan and two annual rounds); short-interval scans are not counted as rounds. The primary cohort closes at 500 signed consents or at 12 months, whichever comes first; participants consented after it closes form an extension cohort, which is excluded from the co-primary outcomes but included in scan-based analyses.
Eligibility
Inclusion Criteria:
- Age 50 to 80 years
- Smoking history of at least 20 pack-years, totalled across all smoked tobacco products (cigarettes, shisha/waterpipe, cigars, pipe and roll-your-own tobacco) using pre-specified equivalency conventions (1 shisha head-year = 1 pack-year; 1 cigar = 4 cigarettes; 1 pipe bowl = 2.5 cigarettes; roll-your-own tobacco 1 g = 1 cigarette). Electronic cigarettes, heated tobacco and smokeless products do not count. Current and former smokers are eligible regardless of time since quitting.
- Able to provide informed consent
Exclusion Criteria:
- Previous diagnosis of lung cancer or any other cancer
- Currently under surveillance for pulmonary nodules
- A major comorbidity under active management (for example end-stage heart, lung or liver disease); people whose condition is under routine follow-up, such as COPD on inhaled treatment, bronchiectasis or interstitial lung disease, remain eligible
- Unable to lie flat with arms raised above the head for CT scanning
- Symptoms suggestive of lung cancer (persistent or worsening cough, haemoptysis, or unexplained weight loss of more than 15 lb (about 7 kg) in the past 3-12 months); symptomatic people are referred the same day on the normal diagnostic pathway
- Chest CT for any reason in the past 12 months
- Non-Kuwaiti residents who have lived in Kuwait for less than 2 years
