COPENHAGEN, Denmark — Screening individuals for lung cancer with low-dose CT without preselection based on their risk profile is associated with a substantial reduction in lung cancer-specific mortality vs no screening, suggested a Chinese analysis.

The cancer detection rate was similar to that in risk-based screening trials, and the study results underscore that early-stage lung cancer detection via screening is associated with markedly improved survival, said Caichen Li, MD, while presenting the research at European Lung Cancer Congress (ELCC) 2026 on March 27.

Li, of the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, Guangzhou, China, and colleagues launched the LUNG-CARE Project, a prospective interventional cohort study involving individuals aged 40-74 years from the same geographic region without a prior lung cancer diagnosis or treatment within 5 years, a chest CT within the past year, or significant cancer-related symptoms.

The participants were enrolled between December 1, 2015, and July 31, 2021, and underwent a single low-dose CT scan and were followed up for incident lung cancer, as well as for survival endpoints.

They were then compared with a “natural control” cohort of individuals undergoing routine medical care and who had not received systematic screening, obtained from the Guangzhou CDC Registry.

Presenting updated and expanded results from those published last year, Li reported that 11,708 individuals were included in the screening group and 114,392 in the control group. The screening group was “slightly older,” he said, with 48.2% vs 46.5% aged 60 years or older, and were more likely to be current smokers, at 17.7% vs 10.9%, and heavy smokers (≥ 20 pack-years), at 12.4% vs 7.6%.

Lung cancer was detected in 227 (1.9%) individuals from the screening group, whereas a lung cancer was diagnosed in 1105 (1.0%) individuals from the unscreened control group.

Li said they saw a “clear stage shift between the two groups,” with around 81.5% of lung cancers in the screening group diagnosed as stage I vs 25.1% in the nonscreening group. Advanced stage disease (III and IV) accounted for 69.7% of cases among control individuals vs 13.7% with screening.

Almost all (93.4%) of the cases in the screening group were adenocarcinoma. Histology heterogeneity was greater in the nonscreening group, with 11.7% of cases squamous cell carcinoma and 5.9% small-cell carcinoma, Li said.

After a median follow-up of 7.0 years, low-dose CT was associated with a significant reduction in lung cancer-specific mortality vs no screening, at a hazard ratio [HR] of 0.45 (P < .001). The effect was more pronounced in women at an HR of 0.28 (P < .001) vs 0.55 (P = .004) in men.

Overall survival at 5 years was also greater with screening, at 87% vs 39% without, or an HR of 0.13 (P < .001).

Li said high-risk patients had significantly poorer survival, regardless of whether using the US National Comprehensive Cancer Network (age ≥ 50 years and ≥ 20 pack-year smoking history) or the more expansive Chinese risk definitions (age > 40 years and one or more risk factors from: 20 pack-year smoking history; environmental/occupational exposure; history of chronic obstructive pulmonary disease/pulmonary fibrosis/tuberculosis; or family history of lung cancer), or when restricting the analysis to patients with respiratory comorbidities or to heavy smokers.

Comparing their results with those from screening trials such as National Lung Screening Trial (NLST), TALENT in Taiwan, and the Female Asian Nonsmoker Screening Study (presented at WCLC 2025), Li said that, despite the broader eligibility of their study, the lung cancer detection rate was comparable, suggesting that these selection criteria for traditional high-risk based screening may be unnecessary.

The results call for the “evaluation of screening strategies beyond conventional risk-based criteria,” and “highlight the need for randomized trials in a nonhigh risk population before broader implementation is considered,” Li specified.

Study Limitations

Li acknowledged that the study was limited by being a nonrandomized comparison and having an imbalance in baseline and disease characteristics between the screened and unscreened cohorts.

Randomized control studies such as the NLST and NELSON have “demonstrated that low-dose CT screening can reduce lung cancer mortality among individuals with a heavy smoking history,” Li noted.

Li also pointed out that current lung screening trials have employed selective strategies targeting high-risk individuals, “rather than evaluating screening in a non-risk-based population.”

Joachim GJV Aerts, MD, PhD, Department of Pulmonary Diseases, Erasmus MC, Rotterdam, Netherlands, who was not involved in the new research, highlighted that the new study started out as a single-arm prospective cohort study with participants recruited, among others means, via social media, and that that control cohort was added later.

Discussing the results on behalf of the European Society for Medical Oncology, he continued that, as the screening population was slightly older and more likely to be smokers, they would likely have been included in a regular risk-based screening study.

Moreover, without follow-up screening, the impact of screening is diluted after about 3-5 years by the normal occurrence of incident lung cancer, as shown in the NELSON trial, in which the lung cancer incidence detection rates were similar between the screening and control groups after approximately 7 years.

Overall, Aerts said that the study “shows, again, that CT screening detects lung cancer in an early stage,” that it increases lung cancer survival, and that the impact is greater in a more healthy population, with the effect lasting “for over 4 years,” although longer follow-up data are required.

Results May Be a ‘Game-Changer’ for Asian Populations

“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,” said Marina Garassino, MD, professor of medicine, hematology and oncology, The University of Chicago Medicine, Chicago, who was not involved in the study, in a press release.

“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.”

Garassino underlined that the current results may be a “game-changer for Asian populations, but we should resist the temptation to over-generalize.”

“Lung cancer in Asia follows a different epidemiological playbook…guidelines built on Western smoking-based data simply do not serve these populations,” she explained.

“What this study does demand, urgently, is updated criteria that recognize Asian ancestry as an independent risk factor for screening eligibility,” she said.

Li declared having no relevant financial relationships. Aerts declared relationships with Eli-Lilly, MSD, AstraZeneca, Accord, PharmaMar, CureVac, Amphera, Nutricia, Genmab, Vivace, Summit, and Amphera. Garassino declared having relationships with AstraZeneca/MedImmune, Bristol‐Myers Squibb, GlaxoSmithKline, MSD, Roche, Takeda, Bayer, Blueprint Medicines, Celgene, Daichii Sankyo, Incyte, Inivata, Janssen, Lilly, Novartis, Pfizer, Regeneron, Sanofi, Seattle Genetics, and Tiziana Life Sciences.