Should low-dose CT scans be recommended for people at low risk for lung cancer?

Lung cancer remains the leading cause of cancer deaths worldwide. Early detection of the disease significantly improves survival rates, making low-dose computed tomography (CT) screening an essential component of lung cancer control. Recent studies, particularly from Asia, have sparked debate about whether the benefits of these tests extend to non-smokers and light smokers.

However, the recently announced Journal of Thoracic OncologyHowever, there is currently insufficient evidence to support screening for lung cancer in people who have never smoked, regardless of whether they have a family history of lung cancer.

The article was written by a group of lung cancer researchers and public health experts. Gerardo A. Silvestri, MD, MScHillenbrand Professor of Thoracic Oncology at the Medical University of South Carolina.

Gerardo A. Silvestri, MD, MSc

Key Point

Dr. Silvestri and his colleagues point out that Taiwan's lung cancer early detection program found that cancer detection rates among light or non-smokers with a family history of lung cancer who underwent low-dose CT screening were more than twice as high as those with 30 or more pack years of radiation exposure who met the U.S. Preventive Services Task Force criteria for high risk. Moreover, more than 90% of cancers detected among those with a family history were at an early stage. Based on these results, the Taiwanese researchers concluded that one-time testing of relatives of those with a family history of lung cancer reduces lung cancer mortality, regardless of smoking history.

However, Dr. Silvestri and his colleagues write, “Findings in this and similar cohorts indicate substantial overdiagnosis and do not adequately take into account the harms associated with testing of populations unlikely to develop fatal cancers.”

According to the article, overdiagnosis of lung cancer can lead to unnecessary treatments and procedures, putting people who may not have developed malignancies at risk. False-positive findings are also a major concern, leading to anxiety, additional testing, and invasive procedures.

“Ultimately, we believe we need to be more discriminating in identifying low-risk individuals who will develop fatal lung cancer rather than indolent lung cancer. What we cannot currently recommend is testing of populations where the risk of harming many people may outweigh the risk of benefiting a few,” the article states.

“The potential benefits in these populations need to be carefully weighed against the risks of harm,” Silvestri and colleagues wrote. “Expanding testing without robust evidence could do more harm than good.”

Given these complexities, the authors advocate for more rigorous research, including randomized controlled trials (which have never been conducted in never-smokers with or without a family history of lung cancer), to better understand the benefits and harms of screening in this group. Furthermore, no randomized trials have been conducted in this population in Asia, where the biology of lung cancer may differ from that observed in Western societies.

Disclosure: For full disclosures from the study authors, please see jto.org.

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