A recent study from China, presented at the European Lung Cancer Congress (ELCC) 2026, indicates that one-time low-dose computed tomography (LDCT) screening may reduce lung cancer mortality in a non-risk-based population, including individuals with no smoking history. These findings suggest a reevaluation of current lung cancer screening eligibility criteria, which predominantly rely on tobacco exposure.
Study Overview
The prospective non-randomized controlled study was conducted between 2017 and 2021 as part of the Chinese LungCare Project. It involved nearly 12,000 adults aged 40–74 in Guangzhou who underwent LDCT screening. This group was compared with a geographically matched control cohort that received standard risk-based care. The participants were followed for seven years.
Key Findings
After seven years of follow-up, the study observed the following:
- LDCT screening was associated with a 55% reduction in lung cancer-specific mortality (HR 0.45; 95% CI 0.32–0.65; P<0.001).
- A mortality benefit was observed across both sexes:
- A 72% risk reduction among women (HR 0.28; 95% CI 0.13–0.60; P<0.001).
- A 45% risk reduction among men (HR 0.55; 95%CI 0.36-0.83, P=0.004).
- Screen-detected cases of lung cancer demonstrated better overall survival compared with the non-screened group (HR 0.13; 95% CI 0.09–0.19; p<0.001).
- In the screening group, 81.5% of cancers were diagnosed at stage I.
- In the non-screening group, 25.1% of cancers were diagnosed at stage I, with approximately 70% of cases diagnosed at advanced stages.
Implications for Screening Guidelines
The results challenge existing eligibility criteria for lung cancer screening, which primarily target long-term or heavy smokers. The study highlights that non-smokers constitute a growing proportion of new lung cancer cases globally, particularly in Asia, potentially linked to factors such as fine particulate matter (PM2.5) in air pollution or genetic susceptibility.
"Current guidelines, based on smoking history, may overlook a demographic of individuals who develop lung cancer despite never having smoked," commented Prof. Marina Garassino from the University of Chicago, who was not involved in the study. She noted that in Asia, never-smoking women represent a significant share of lung cancer cases, influenced by factors like air pollution and genetic risk.
Prof. Garassino stated that the LUNG-CARE Project indicates that screening beyond conventional risk criteria can lead to earlier disease detection, with a majority of screen-detected cancers being Stage I, which correlates with improved survival outcomes. She also suggested that the findings are particularly impactful for Asian populations, where lung cancer epidemiology differs from Western populations, which have guidelines based on smoking history, and may highlight the need for updated criteria that could recognize Asian ancestry as a risk factor for screening eligibility.
Implementation Challenges
Implementing widespread LDCT screening programs may present several challenges:
- The costs of imaging and subsequent follow-up tests after positive results could strain certain health systems, despite potential cost-effectiveness in some settings.
- LDCT has an approximate 8% false positive rate, which may lead to unnecessary invasive procedures, increased costs, and patient anxiety.
- Adoption into national programs has been slow, and participation remains uneven due to barriers such as fear of diagnosis and low perceived personal risk.