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Publications

Journal Article Review Ppublish

PubMed: 41651571 DOI: 10.1016/j.jtho.2025.11.017

A Game-Changing 20 Years: Progress and Future Directions in Lung Cancer Screening.

J Thorac Oncol 21(2):235-252

Authors: Stephen Lam, David R Baldwin, Anand Devaraj, John Field, Claudia I Henschke, Marjolein A Heuvelmans, Rudolf M Huber, Catherine Jones, Andrea Borondy-Kitts, Molly Siu Ching Li, Renelle Myers, Raymond U Osarogiagbon, Hilary A Robbins, Martin C Tammemägi, Kathryn L Taylor, Natthaya Triphuridet, Randi M Williams, David Yankelevitz

Affiliations

  • Department of Basic and Translational Sciences, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
  • Department of Respiratory Medicine, Nottingham University Hospitals, NHS Trust, Nottingham, United Kingdom.
  • Department of Radiology, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom.
  • Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool, United Kingdom.
  • Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Research Institute for Diagnostic Accuracy, Groningen, The Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Respiratory Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands.
  • Ludwig-Maximilians-Universität in Munich, Thoracic Oncology Centre, Munich, Germany; German Center for Lung Research (DZL CPC.M), Munich, Germany.
  • I-MED Radiology Network, Queensland, Australia.
  • Rescue Lung Society, Amesbury, Massachusetts.
  • State Key Lab of Translational Oncology, Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China.
  • Department of Basic and Translational Sciences, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
  • Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee.
  • International Agency for Research on Cancer, Lyon, France.
  • Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada.
  • Department of Oncology, Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown, University Medical Center, Washington, District of Columbia.
  • Princess Srisavangavadhana Faculty of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand.

Abstract

In the past two decades, lung cancer screening (LCS) with low-dose computed tomography (LDCT) has emerged as one of the most effective strategies for reducing lung cancer mortality. Landmark trials, including NLST and NELSON, demonstrated mortality reductions exceeding 20%, establishing LDCT as the standard of care for early detection in high-risk populations. Currently, 13 countries have implemented national or regional LCS programs, with additional nations preparing for rollout. Advances in risk-prediction models, volumetric nodule assessment, and structured management protocols have improved precision and efficiency. Integration of artificial intelligence is enhancing nodule detection, prediction of malignancy risk, individualized screening intervals, and workflow optimization. Real-world evidence confirms improved stage distribution and suggests reduction in lung cancer mortality. Initiatives such as promoting community engagement, equitable access through geospatial mapping, and mobile screening will improve screening uptake and retention. Embedding tobacco dependence treatment within LCS further augments life-years gained. Complementary incidental pulmonary-nodule programs and expanding studies in people who have never smoked are extending the reach of early detection, whereas biomarker research is progressing toward integration with imaging-based screening. The potential to use LDCT scans to detect coronary heart disease and chronic obstructive pulmonary disease may have a major impact on future health care benefits. Ongoing efforts to harmonize data collection standards, establish quality indicators, and strengthen workforce training are essential to sustain high-quality implementation. As LCS evolves into a cornerstone of lung cancer control, continued innovation in risk stratification, imaging technologies, and biomarker integration will be key to maximizing global benefit and equity.

MeSH

Mortality, Lung, Thoracic Neoplasms, Neoplasms, Biomarkers, Lung Neoplasms