Lung Cancer Screening in Low-Risk Individuals: More Harm Than Good?

By: Julia Cipriano, MS
Posted: Friday, August 23, 2024

Annual low-dose CT screening for lung cancer has reduced mortality in high-risk individuals, thus sparking a debate on whether this survival benefit may extend to those who have never smoked. However, in a perspective published in the Journal of Thoracic Oncology, Gerard A. Silvestri, MD, MS, of the Medical University of South Carolina, Charleston, and colleagues revealed there is currently insufficient evidence to support such screening for this low-risk population with or without a family history of lung cancer. 

The Early Detection Program for Lung Cancer in Taiwan reported that the cancer detection rate among those screened with low-dose CT was more than twofold higher in light- or never-smokers with a family history compared with high-risk persons with more than 30 pack-years of exposure and meeting U.S. Preventive Services Task Force criteria. In addition, nearly all the cancers detected in individuals with a family history were early stage (> 90%).

The Taiwanese researchers concluded that screening the first-degree relatives of individuals with a family history of lung cancer, irrespective of smoking history, may decrease lung cancer mortality. However, according to the article, the findings in this cohort—and others like it—represent substantial overdiagnosis. The authors suggested such overdiagnosis of lung cancer may lead to unnecessary interventions, introducing risks to individuals with a low likelihood of developing aggressive disease.

“We need to carefully weigh the potential benefits against the risks of harm in these populations,” Dr. Silvestri stated in an International Association for the Study of Lung Cancer press release. “Extending screening without robust evidence could lead to more harm than good.” The authors thus advocated for the conduct of the first randomized trials in never-smokers with or without a family history and in Asians, as unique disease biology in the latter necessitates further research before implementing population-based screening.

Disclosure: For full disclosures of the study authors, visit jto.org.

Journal of Thoracic Oncology

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