Low-Dose CT Screening Reduces Lung Cancer-Specific Mortality

The use of low-dose CT screening correlated with lower lung cancer-specific mortality in a non–risk-based lung cancer population, according to findings from the LUNG-CARE Project (NCT04938804) presented at the 2026 European Lung Cancer Congress.¹

Low-dose CT screening demonstrated a substantial reduction in mortality compared with routine medical care across the overall study population (HR, 0.45; 95% CI, 0.32-0.65; P <.001). Additionally, a more pronounced benefit was observed among female patients (HR, 0.28; 95% CI, 0.13-0.60; P <.001), with a numerically lower reduction in mortality risk reported across the male population (HR, 0.55; 95% CI, 0.36-0.83; P = .004).

Additional data showed that patients with screen-detected cancers experienced better overall survival (OS), with a 5-year OS rate of 87% vs 39% in those without screen-detected disease (HR, 0.13; 95% CI, 0.09-0.19; P <.001). Based on NCCN and Chinese risk definitions, significantly worse survival outcomes were noted among high-risk populations (P <.001). Additionally, respiratory comorbidities and heavy smoking emerged as adverse prognostic drivers for survival (P <.001).

“The LUNG-CARE Project represents the first prospective non–risk-based lung cancer screening program and was associated with lower lung cancer-specific mortality than that observed in a contemporaneous non-screened population from the same region. Compared with traditionally defined ‘high-risk’ individuals, ‘non–high-risk’ patients showed better survival and greater curative potential through early detection,” study investigator Caichen Li, MD, from the First Affiliated Hospital of Guangzhou Medical University, stated in his presentation of the findings. “Evaluation of screening strategies beyond conventional risk-based criteria highlight the need for randomized trials in non–high-risk populations before broader implementation is considered.”

As part of the LUNG-CARE Project, a prospective interventional cohort study, investigators enrolled patients 40 to 74 years old from the same geographic region between December 2015 and July 2021. Individuals were assigned to undergo a 1-time low-dose CT screening (n = 11,708) or routine medical care with no systematic screening (n = 114,392). Overall, investigators reported 227 patients with lung cancer in the screening group compared with 1105 in the non-screening group.

The study’s primary end point was the lung cancer detection rate. Exploratory analyses focused on lung cancer-specific mortality and OS among all lung cancer cases.

Individuals who had a diagnosis or therapy related to lung cancer within 5 years of study entry, prior chest CT within the past year, or significant symptoms associated with cancer were ineligible for enrollment on the study.²

At baseline, most patients in the non-screening and screening groups were female (53.5% vs 53.4%) and had no history of tobacco use (80.7% vs 69.2%). Among patients who had a diagnosis of lung cancer, most patients in the non-screening group had stage IV disease (51.7%), and most in the screening group had stage I disease (81.5%). Most patients in each group had adenocarcinoma histology (72.3% vs 93.4%).

Across the LUNG-CARE Project, the baseline lung cancer detection rate was 1.9% for in situ and minimally invasive disease only and 1.4% when accounting for invasive adenocarcinoma only. Despite the LUNG-CARE Project’s more general population, Li noted that lung cancer detection rates were comparable with those from other high-risk screening studies, including the TALENT and NLST studies.^3,4

According to Li, a limitation of the study is its non-randomized comparison with potential residual confounding. Other limitations included an imbalance in baseline and disease characteristics between the screened and non-screened cohorts, the post-diagnosis survival analyses being susceptible to lead-time bias and overdiagnosis, and limited external generalizability based on its single-region and 1-time screening design.

Li declared no competing financial interests.

References

1. Li C, He J, Liang W, et al. The impact of one-time low-dose CT screening on lung cancer mortality in a non–risk-based population: a prospective non-randomized controlled study. Presented at the 2026 European Lung Cancer Congress; March 25-28, 2026; Copenhagen, Denmark. Abstract LBA5.
2. Non-risk based lang cancer screening with a one-off LDCT. ClinicalTrials.gov. Updated January 9, 2024. Accessed March 27, 2026. https://tinyurl.com/2rfztuxs
3. Chang GC, Chiu CH, Yu CJ, et al. Low-dose CT screening among never-smokers with or without a family history of lung cancer in Taiwan: a prospective cohort study. Lancet Respir Med. 2024;12(2):141-152. doi:10.1016/S2213-2600(23)00338-7
4. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409. doi:10.1056/NEJMoa1102873