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The challenges of implementing low-dose computed tomography for lung cancer screening in low- and middle-income countries

Nature Cancer volume 1, pages 1140–1152 (2020)Cite this article

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Abstract

Lung cancer accounts for an alarming human and economic burden in low- and middle-income countries (LMICs). Recent landmark trials from high-income countries (HICs) by demonstrating that low-dose computed tomography (LDCT) screening effectively reduces lung cancer mortality have engendered enthusiasm for this approach. Here we examine the effectiveness and affordability of LDCT screening from the viewpoint of LMICs. We consider resource-restricted perspectives and discuss implementation challenges and strategies to enhance the feasibility and cost-effectiveness of LDCT screening in LMICs.

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Fig. 1: The growing disparities in lung cancer incidence, mortality and case fatality between LMICs and HICs over time.

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Authors and Affiliations

  1. Department of Medicine, Jackson Memorial Hospital/University of Miami, Miami, FL, USA

    Eduardo Edelman Saul

  2. Centro Paulista de Oncologia–Oncoclinicas Group, São Paulo, Brazil

    Raquel B. Guerra

  3. Department of Medicine, Universidade Estácio de Sá, Rio de Janeiro, Brazil

    Michelle Edelman Saul

  4. Department of Medicine, Metrowest Medical Center/Tufts University School of Medicine, Framingham, MA, USA

    Laercio Lopes da Silva

  5. Department of Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Gabriel F. P. Aleixo

  6. Division of Oncology, Oncoclinicas Group, Brasilia, Brazil

    Raquel M. K. Matuda

  7. Division of Hematology-Oncology, Department of Medicine, Miller School of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA

    Gilberto Lopes

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  1. Eduardo Edelman Saul
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  2. Raquel B. Guerra
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  3. Michelle Edelman Saul
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  4. Laercio Lopes da Silva
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  7. Gilberto Lopes
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Contributions

Conception and design, E.E.S., R.B.G., M.E.S., L.L.S., G.F.P.A., R.M.K.M. and G.L.; collection assembly of data, E.E.S., R.B.G., M.E.S., L.L.S., G.F.P.A., R.M.K.M. and G.L.; data analysis and interpretation, E.E.S., R.B.G., M.E.S., L.L.S. and G.L.; manuscript writing, E.E.S., R.B.G., L.L.d.S., M.E.S., G.F.P.A. and G.L.; tables and figures, E.E.S., M.E.S., L.L.d.S., G.F.P.A., G.L.; and final approval, E.E.S., R.B.G., M.E.S., L.L.d.S., G.F.P.A., R.M.K.M. and G.L.

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Correspondence to Eduardo Edelman Saul.

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Edelman Saul, E., Guerra, R.B., Edelman Saul, M. et al. The challenges of implementing low-dose computed tomography for lung cancer screening in low- and middle-income countries. Nat Cancer 1, 1140–1152 (2020). https://doi.org/10.1038/s43018-020-00142-z

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