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Gender Disparities and Lung Cancer Screening Outcomes Among Individuals Who Have Never Smoked
Yeon Wook Kim1,2, Dong-Hyun Joo1, So Yeon Kim3
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
JAMA Network Open
|January 15, 2025
Summary
Lung cancer screening in never-smokers showed no significant sex differences in diagnosis or outcomes. This suggests similar risks of overdiagnosis and limited benefit for both men and women undergoing opportunistic low-dose computed tomography screening.
Area of Science:
- Oncology
- Public Health
- Radiology
Background:
- Lung cancer in never-smokers (INS) is a growing concern, particularly in East Asia.
- Opportunistic lung cancer screening (LCS) programs are increasingly used for INS.
- Sex-specific outcomes of LCS for INS remain under-explored, with a focus on women.
Purpose of the Study:
- To compare lung cancer screening outcomes between Asian women and men with no smoking history.
- To evaluate sex-based differences in lung cancer diagnosis, stage, and mortality after low-dose computed tomography (LDCT) screening.
Main Methods:
- Multicenter cohort study in South Korea (2009-2021) including individuals aged 50-80 with no smoking history.
- Retrospective analysis of opportunistic LDCT screening data.
- Comparison of lung cancer diagnosis, stage, histologic type, and lung cancer-specific death (LCSD) between sexes, with follow-up until December 2022.
Main Results:
- 21,062 participants (76.6% women) underwent LDCT screening.
- No significant sex-based differences were observed in screen-detected lung cancer rates (0.9% women vs. 0.8% men), stage distribution (predominantly stage 0-I), or histologic type (adenocarcinoma).
- Multivariable analyses revealed no significant association between sex and the cumulative hazards of lung cancer diagnosis or LCSD; 5-year survival rates were similar.
Conclusions:
- Opportunistic LDCT screening for lung cancer in never-smoking Asian individuals revealed no significant sex-based differences in outcomes.
- Findings suggest comparable risks of overdiagnosis and limited benefit for both men and women undergoing indiscriminate screening.
- Further research may be needed to refine screening strategies for specific populations.
