A single CT screening can change the game and positively impact survival in lung cancer.Data from a large, prospective, non-randomized study in China show that one-time low-dose computed tomography (LDCT) screening is associated with a significant reduction in lung cancer mortality in a non–risk-based population, including those who have never smoked.
“The LUNG-CARE Project represents the first prospective non–risk-based lung cancer screening programme and was associated with lower lung-cancer specific mortality than that observed in a contemporaneous non-screened population from the same region,” said Dr Caichen Li from The First Affiliated Hospital of Guangzhou Medical University in China, who presented the findings at ELCC 2026.
After a median follow-up of 7 years, LDCT screening halved the incidence of lung cancer-specific mortality (hazard ratio [HR], 0.45; p<0.001). The mortality benefit was evident across sexes, with a more pronounced effect among women (HR, 0.28; p<0.001) than men (HR, 0.55; p=0.004). [ELCC 2026, abstract LBA 5]
In the subgroup of patients diagnosed with lung cancer during the study period, 81.5 percent of cases in the screened group (n=227) were diagnosed at stage 1; the corresponding rate in the non-screened group (n=1,105) was only 25.1 percent. Conversely, the latter had a higher incidence of stage III/IV disease than the former (69.7 percent vs 13.7 percent). The predominant histologic subtype was adenocarcinoma (93.4 percent and 72.3 percent in the screened and non-screened groups, respectively).
The 5-year overall survival was significantly better among those who had screen-detected lung cancer than those who did not (87 percent vs 39 percent; HR, 0.13; p<0.001).
“Using both NCCN* guidelines and Chinese** risk definitions, high-risk patients had significantly poorer survival, with heavy smoking and chronic obstructive pulmonary disease (COPD) emerging as key adverse prognostic drivers,” said Li.
In this study, the screened cohort included 11,708 participants within the Guangzhou LUNG-CARE Project who completed a one-time LDCT (53.4 percent women). Of these, 69.2 percent had no history of tobacco use, but 17.7 percent were current tobacco users, and 12.4 percent had a ≥20 pack-year history.
The non-screened control group included individuals from the Guangzhou CDC Registry who received routine medical care without systematic screening (n=114,392; 53.5 percent women).
According to Li and colleagues, the findings challenge current eligibility criteria for lung cancer screening in most countries, which focus on heavy or long-time smokers. This omits individuals who develop lung cancer despite never having smoked.
Nonsmokers make up a substantial proportion of new lung cancer cases in several parts of the world, including Asia, and most cases are attributed to other factors such as fine particulate matter in air pollution or genetic susceptibility. [CA Cancer J Clin 2024;74:229-263; J Natl Cancer Inst 2017;109:djw295]
In the ELCC press release, Prof Marina Garassino from the University of Chicago, Illinois, US, who was not involved in the study, commented, “Current screening guidelines were built around smoking history, and in doing so, they leave behind a large and growing group of people who develop lung cancer despite never having smoked. In Asia, this is not a marginal issue: never-smoking women represent a substantial share of all lung cancer cases, driven by factors like air pollution and genetic risk rather than tobacco.”
“The LUNG-CARE Project shows that, when we screen beyond conventional risk criteria, we catch disease earlier, over 80 percent of screen-detected cancers were stage 1, and that translates directly into lives saved. A 72-percent reduction in mortality in women is not a signal to note; it is a signal to act on,” Garassino added.
However, the implementation of mass LDCT screening is not without challenges. Positive test results entail costs that may be unsustainable for some healthcare systems. Moreover, the high false positive rate with LDCT can lead to unnecessary invasive procedures, additional costs, and patient anxiety.
Its integration into national programmes has thus been slow, and in regions where it’s offered, patient participation is variable due to low perceived personal risk and fear of diagnosis. [J Gen Intern Med 2020;35:3015-3025; Respir Res 2022;23:374]
Li also acknowledged certain limitations, such as the non-randomized, single-region, one-time screening design; non-balanced baseline and disease characteristics between groups; and post-diagnosis survival analyses.
“[Nonetheless,] this is a game-changer for Asian populations,” Garassino said. “However, we should resist the temptation to over-generalize. Lung cancer in Asia follows a different epidemiological playbook: never-smokers, women, environmental exposures, and guidelines built on Western smoking-based data simply do not serve these populations.”
“On the other hand, Western guidelines cannot simply copy-paste these results. What this study does demand, urgently, is updated criteria that recognize Asian ancestry as an independent risk factor for screening eligibility,” Garassino added.
“Evaluating screening strategies beyond conventional risk-based criteria highlights the need for randomized trials in non–high-risk populations before broader implementation is considered,” Li said.