COPENHAGEN, Denmark, 27 March 2026 – New evidence from a Chinese cohort presented today at the European Lung Cancer Congress (ELCC) 2026 shows that onetime lowdose computed tomography (LDCT) screening can significantly reduce lung cancer mortality in a non–risk based population, including individuals with no smoking history. (1) The findings support reconsideration of current eligibility criteria, which still rely heavily on tobacco exposure.
In the prospective non-randomised controlled study conducted between 2017 and 2021 within the Chinese LungCare Project, nearly 12,000 adults aged 40–74 in Guangzhou underwent LDCT screening and were compared with a geographically matched control cohort receiving standard risk based care. After seven years of follow up, 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). The mortality benefit was observed across sexes and was particularly pronounced among women with 72% risk reduction (HR 0.28; 95% CI 0.13–0.60; P<0.001) compared to male (HR 0.55; 95%CI 0.36–0.83, P=0.004). Among patients diagnosed with lung cancer over the course of the study period, screen-detected cases demonstrated significantly 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, compared with 25.1% in the non-screening group. In contrast, advanced-stage disease accounted for about 70% of cases in the non-screened group.
These results challenge how countries currently decide who is eligible for lung cancer screening. Today, most screening programmes mainly target longtime or heavy smokers. However, this approach overlooks a rapidly growing group: people who develop lung cancer despite never having smoked. In many parts of the world—especially in Asia but increasingly also elsewhere (2)—nonsmokers make up a substantial proportion of new lung cancer cases (3), often linked to factors like fine particulate matter (PM2.5) in air pollution or genetic susceptibility.
"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% of screen-detected cancers were Stage I, and that translates directly into lives saved. A 72% mortality reduction in women is not a signal to note; it is a signal to act on.", commented Prof. Marina Garassino, University of Chicago, who was not involved in the study.
Implementing mass LDCT screening comes with challenges. Although broader screening can be cost effective in some settings, the costs of imaging and follow up tests after positive results may be difficult for certain health systems to sustain. LDCT also has a relatively high false positive rate—about 8% (4) —which can lead to unnecessary invasive procedures, added costs, and patient anxiety. As a result, adoption into national programmes has been slow, and where screening is available, participation remains uneven due to barriers such as fear of diagnosis and low perceived personal risk. (5)
"This is a game-changer for Asian populations, but we should resist the temptation to over-generalise. 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 recognise Asian ancestry as an independent risk factor for screening eligibility," Garassino concluded.
