2026 IASLC CT Screening and Early Detection Symposium-WS02.05 - Talk 1: Unmet Needs in Lung Cancer Screening for People who Never Smoked

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This presentation addressed unmet needs in lung cancer screening for people who have never smoked. Although up to 25% of lung cancers globally occur in never-smokers, current screening guidelines from the USPSTF and American Cancer Society remain largely smoking-centered, leaving many at-risk individuals ineligible for low-dose CT (LDCT) screening.<br /><br />The talk emphasized that lung cancer risk is multifactorial and cannot be captured by pack-years alone. Important factors include family history, ancestry, sex, ambient air pollution, indoor combustion, radon, occupational exposures, secondhand smoke, prior lung disease, and emerging genomic or molecular signals. The key challenge is to identify treatment-relevant cancers while avoiding overdiagnosis, especially of indolent adenocarcinoma-spectrum lesions.<br /><br />Evidence from East Asian cohorts, particularly the TALENT study in Taiwan, suggests that LDCT can detect early lung cancer in risk-enriched never-smokers, and that first-degree family history may be a useful enrichment variable. However, important uncertainties remain, including whether screening reduces late-stage disease and mortality, and how to define appropriate screening intervals, stopping rules, and harm thresholds.<br /><br />The speaker proposed a person-centered, risk-enriched pathway rather than a binary “screen everyone” or “screen no one” approach. This framework includes risk intake, calibrated risk modeling, shared decision-making, standardized nodule management, and outcome tracking through registries. The roadmap for the field is to better define eligible risk, focus on consequential cancers, measure benefit and harm rigorously, and implement screening responsibly with transparent AI use and careful clinical judgment.

Asset Subtitle

Dawei Yang

Meta Tag

Concept Chest Screening

Concept Never-Smoker

Concept Lung Cancer Screening CT

Concept Eligibility Criteria

Concept Smoking History

Speaker Dawei Yang

Keywords

lung cancer screening

never-smokers

low-dose CT

LDCT

risk modeling

family history

overdiagnosis

adenocarcinoma

shared decision-making

TALENT study

Chest Screening

Never-Smoker

Lung Cancer Screening CT

Eligibility Criteria

Smoking History

Dawei Yang