Non-smoking women need more attention in lung cancer screening: A real-world study from China

Seniors with a history of heavy smoking were defined as high-risk populations for lung cancer according to the National Comprehensive Cancer Network (NCCN) Lung Cancer Screening Guideline. We did a real-world study to explore the efficacy of the current NCCN Lung Cancer Screening Guidelines in the context of the real-life Chinese populations and possible directions for improvement.

We collected hospital data from 2595 consecutive patients first diagnosed with lung cancer, comprising 1288 men and 1307 women. Analysing the distribution of lung cancer tumour characteristics and risk factors in different age and sex groups. Additionally, the number and proportion of high-risk populations in different sexes were calculated based on the NCCN Lung Cancer Screening Guidelines.

There were significant differences in the distribution of tumour characteristics and risk factors across sex and age groups. The proportions of lung adenocarcinoma and non-smokers were significantly higher in female patients compared with male patients. Older male patients showed significantly higher proportions of squamous cell carcinoma and heavy smokers than younger male patients. According to the NCCN screening criteria, there were 649 high-risk men and only 12 high-risk women. The proportion of high-risk populations in the aged lung cancer patients was 58.6 % in men and 1.2 % in women.

In China, only a minority of female lung cancer patients meet the definition of the high-risk populations for the NCCN lung cancer screening guidelines. Future lung cancer screening strategies for the Chinese population should focus more on younger populations and pay greater attention to non-smoking women to avoid high rates of underdiagnosis.