2026 IASLC CT Screening and Early Detection Symposium-WS02.04 - Talk 4: Challenges for the Implementation of Biomarkers into Lung Cancer Screening Programs

Pdf Summary

The presentation argues that the main challenge for biomarkers in lung cancer screening is not proving that screening works—low-dose CT already performs well—but finding where additional biomarkers can add value without creating unnecessary complexity. CT screening has shown improved early-stage detection and reduced late-stage disease, and lesion growth over time is highlighted as a powerful existing biomarker of malignancy.<br /><br />The speaker outlines three possible roles for biomarkers in the screening pathway: before CT, instead of CT, or after CT. Before CT, biomarkers could help determine eligibility for screening, potentially improving on risk models based on smoking history alone. However, this approach faces major barriers: many lab tests are more expensive than CT, may be viewed by regulators as a completely new screening program, and require population-specific validation.<br /><br />After CT, biomarkers could help manage indeterminate pulmonary nodules by “ruling in” malignancy for biopsy or “ruling out” malignancy to avoid unnecessary follow-up. This requires very strong performance—high specificity and positive predictive value for rule-in tests, or high sensitivity and negative predictive value for rule-out tests. The same logic applies to blood tests used alongside CT.<br /><br />The talk also highlights unmet needs where biomarkers might be especially useful: people who never smoked, particularly East Asian women; patients facing delays for follow-up CT scans; and individuals with interstitial lung abnormalities detected during screening, where management remains uncertain.<br /><br />Overall, biomarkers may be most valuable where current CT-based pathways leave gaps, but successful implementation will depend on demonstrating real-world benefit, cost-effectiveness, and clear placement within the screening workflow.

Asset Subtitle

Sebastian Schmidt

Meta Tag

Concept Low-Dose CT Lung Cancer Screening

Concept Biomarker

Concept Chest Screening

Concept Eligibility Criteria

Concept Risk Model

Speaker Sebastian Schmidt

Keywords

lung cancer screening

low-dose CT

biomarkers

pulmonary nodules

risk models

malignancy

screening eligibility

interstitial lung abnormalities

cost-effectiveness

follow-up CT

Low-Dose CT Lung Cancer Screening

Biomarker

Chest Screening

Eligibility Criteria

Risk Model

Sebastian Schmidt