Special Session 5 - Prevention and Cure of Common Cancers

Lung cancer remains the leading cause of cancer incidence and mortality in Hong Kong. This is largely due to the fact that early-stage lung cancer is often asymptomatic, with over half of patients presenting with incurable metastatic disease. Randomized controlled trials have shown that lung cancer screening with low dose computed tomography leads to stage migration and reduces mortality among smokers, which is now recommended in many countries. However, in Hong Kong, lung cancer screening is not routinely implemented, primarily due to lack of local data and several ongoing challenges. Firstly, current recommendations, based on age and smoking history, may fail to identify up to half of at-risk smokers. In Hong Kong, up to 50% of lung cancer occur in non-smokers, meaning that many high-risk individuals fall outside existing screening criteria. Secondly, LDCT has a relatively low positive predictive value, resulting in frequent false positives, unnecessary invasive procedures, and overtreatment. Thirdly, access to screening is constrained by high costs and shortage of radiologists. Finally, public awareness, uptake and adherence to screening remain low, limiting the effectiveness of screening at the population level. 
Emerging technologies and strategies are showing promise in addressing these gaps. Advances in genomic and other risk factor profiling have enabled the development of integrated risk models that more accurately identify at-risk individuals than traditional criteria. Artificial intelligence is being incorporated into imaging workflows to improve nodule detection and malignancy risk assessment, while reducing dependence on radiologist interpretation and lowering costs. Non-invasive biomarkers, including plasma-based assays (e.g. methylomic, fragmentomics), breath and urine tests – offer additional value for refining eligibility and guiding the need for invasive workup. The Chinese University of Hong Kong is conducting a prospective study investigating the use of artificial intelligence as first-reader for lung cancer screening and nodule detection among high-risk never smokers. Interim results will be presented. With emerging data, we hope to establish an inclusive, precise and cost-effective lung cancer screening programme that benefit both smokers and non-smokers in Hong Kong.

Hepatocellular carcinoma (HCC) is highly preventable. Overall, 2/3 of HCC cases are attributable to five risk factors: chronic infection with hepatitis C virus (HCV), hepatitis B virus (HBV), excess alcohol associated liver disease (ALD), overweight/obesity associated liver diseases (metabolic dysfunction associated steatotic liver disease or MASLD), and tobacco smoking.  HCV and HBV screening and treatment, ALD and MASLD screening with subsequent behavioral and pharmacological interventions hold the promise of reducing HCC incidence and mortality. Notably, the preventable burden differs by race/ethnicity and by sex. The risk factor profile for HCC is changing from less prevalent but highly potent factors (HBV and HCV) to highly prevalent but less potent factors (ALD and MASLD). This shift highlights the crucial role of HCC risk stratification among people with ALD and MASLD. . I present a framework that outlines steps and interfaces along the cancer care continuum that are required for effective HCC prevention. These steps include risk assessment, primary prevention, detection (i.e., screening initiation and follow-up of screening results), diagnosis, and treatment. Each of these steps is prone to failures that are influenced by factors at multiple socioecological levels (i.e., patient, provider, health delivery system, community, and policy levels).  Focusing on early steps in the framework, including risk assessment, primary prevention, and early detection may have the greatest potential to reduce HCC mortality.

Advances in the diagnosis and treatment of hepatobiliary pancreatic (HBP) cancers, comprising liver, bile duct, and pancreatic cancers, are crucial as their incidence continues to rise globally. Historically, progress in treating HBP cancers lagged behind other common cancers such as breast and lung cancer. However, remarkable advancements over the past five years have significantly altered this landscape. For hepatocellular carcinoma (HCC) and biliary tract cancers, the introduction of immunotherapy-based regimens has led to possibly long-term survival of patients with advanced disease. The current development aim to increase cure rates through the combination of various therapeutic modalities. In pancreatic cancer, despite challenges in developing effective targeted therapies or immunotherapy, recent innovations offer hope. Novel KRAS inhibitors and vaccine therapies are promising, Collectively, these advancements represent a pivotal shift towards more effective and sustainable treatment options for patients afflicted by HBP cancers, underscoring the importance of continued research and clinical trials to further enhance patient outcomes.