Lung cancer remains the leading cause of cancer-related deaths worldwide. Detecting this disease in its early stages significantly improves survival rates, making low-dose computed tomography (CT) screening an essential component in the fight against lung cancer. Following the mortality reduction recognised from annual low-radiation dose CT by screening those at high-risk, there has been consideration that this benefit could translate to those who have never smoked.
However, according to a recently published article in the Journal of Thoracic Oncology, there is currently insufficient evidence to support lung cancer screening for those who never smoked with or without a family history of lung cancer.1
“The Early Detection Program for Lung Cancer in Taiwan” revealed that the cancer detection rate for those screened with low-radiation dose computed tomography was more than two-fold higher in light- or never-smokers with a family history of lung cancer compared with high-risk persons with more than 30 pack-years exposure and meeting U.S. Preventative Services Task Force criteria. In addition, more than 90% of the cancers detected in those with a family history were in early-stage. On the basis of those findings, the Taiwan researchers concluded that screening first-degree relatives of those with a family history of lung cancer, irrespective of smoking history, would lead to a decrease in lung cancer mortality.
Silvestri et al. however note that the findings in this cohort, and others like it, represent substantial over-diagnosis and indicate that the harms associated with screening a population that has a low probability of developing fatal cancers have not been thoroughly considered. Over-diagnosis can lead to unnecessary treatments and procedures, posing risks to individuals who might never develop life-threatening cancer. False positives are also a concern, resulting in anxiety, additional tests, and invasive procedures.1
Given these complexities, more rigorous research is advocated, including randomised controlled trials, which have never been performed in those who have never smoked with or without a family history of lung cancer, to better understand the benefits and harms of screening in this group. Furthermore, no randomised trials for this population have ever been undertaken in Asia where it appears that the biology of lung cancer is different than that observed in Western societies.1
REFERENCE
https://www.jto.org/article/S1556-0864(24)00206-5/fulltext1. Silvestri GA, Young RP, Tanner NT, et al. Screening Low-Risk Individuals for Lung Cancer: The Need May Be Present, but the Evidence of Benefit Is Not. J Thorac Oncol. 2024;19(8):1155-63.
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