Lung screening eligibility by risk score, not pack-years, including high-risk never-smokers
Pack-year rules miss many people who get lung cancer, including East Asian women who never smoked. A risk score with family history and ancestry would find more cancers per scan.
PLCOm2012 risk-based selection is more efficient than USPSTF criteria; Taiwan's TALENT study found high detection in never-smoking women with family history. Propose eligibility by a validated risk model with a threshold (e.g. 1.5% six-year risk) plus a never-smoker arm for populations with high never-smoker incidence.
- Most lethal cancers are found late · Screening exists for only a few cancers. Pancreatic, ovarian, liver, oesophageal and most lung cancers are found when cure is unlikely.
- Trials do not represent the people who get cancer · Older, Black, Hispanic, Asian, rural, poor and multimorbid patients are under-represented, so results may not apply to them.
Lung screening works when it uses volumetric nodule management, and it works against a no-screening control. The protocol underpins the UK Targeted Lung Health Check programme and European recommendations. Benefit in women remains less precisely estimated.
For people with a heavy smoking history, an annual low-dose CT scan is one of the few screening tests proven to reduce cancer deaths. Most abnormal scans are not cancer, so screening must be paired with careful nodule management. It does not apply to never-smokers or light smokers.