Lung Cancer Screening in Cancer Survivors vs Those Without a History of Cancer

Cancer survivorship in the US is increasing greatly, and cancer survivors are at increased risk of developing second primary cancers, with lung cancer being the most common. However, data on lung cancer screening (LCS) with low-dose computed tomography (LDCT) in cancer survivors are lacking.

To compare characteristics, LDCT interpretation, lung cancer detection rate (CDR), and all-cause mortality rate among cancer survivors vs individuals without prior cancer undergoing LCS.

This cohort study used North Carolina Lung Screening Registry (NCLSR) data from 2015 to 2019 among individuals undergoing LCS at 8 sites in North Carolina. The NCLSR was linked with the North Carolina Central Cancer Registry from 2000 to 2020 to identify cancer survivors and individuals without prior cancer. Data analysis was performed from June 2024 to April 2025.

Undergoing LCS.

The primary outcome was whether lung cancer was diagnosed within 1 year after the first LCS examination. Comparison of demographic characteristics between cancer survivors and those without prior cancer was performed with χ2 tests. The association of previous cancer with LDCT interpretation, lung CDR, and all-cause mortality rate was modeled using logistic regression.

Of a total of 7295 individuals (mean [SD] age, 64.71 [6.34] years), 814 were cancer survivors (425 men [52.2%]), and 6481 (3290 men [50.8%]) had no history of cancer. Compared with the individuals without prior cancer, cancer survivors were older (3267 individuals without prior cancer [50.4%] vs 501 cancer survivors [61.6%] were aged ≥65 years; χ21 = 35.93; P < .001), were more likely to be Black than White or other races (871 individuals without prior cancer [13.4%] vs 137 cancer survivors [16.8%] were Black; χ22 = 12.46; P = .002), were more likely to have formerly vs currently smoked (2728 individuals without prior cancer [42.7%] vs 418 cancer survivors [51.9%] formerly smoked; χ22 = 24.62; P < .001), and had higher rates of respiratory comorbidities (1834 individuals without prior cancer [35.0%] vs 268 cancer survivors [39.9%]; χ21 = 6.19; P = .01) and cardiovascular comorbidities (3043 individuals without prior cancer [58.1%] vs 432 cancer survivors [64.4%]; χ21 = 9.70; P = .002). Cancer survivors and those without prior cancer had similar adjusted rates of positive LDCT results (120 of 758 cancer survivors [15.8%] vs 1032 of 6059 individuals without prior cancer [17.0%]; χ21 = 0.86; P = .35). The adjusted lung CDRs were 26.0 cases per 1000 (95% CI, 17.0-38.2 cases per 1000) among cancer survivors vs 17.0 cases per 1000 (95% CI, 14.1-20.6 cases per 1000) among those without prior cancer (χ21 = 3.38; P = .07); the all-cause mortality rates were 19.4 cases per 1000 (95% CI, 12.0-31.3 cases per 1000) among cancer survivors vs 17.1 cases per 1000 (95% CI, 14.1-20.6 cases per 1000) among those without prior cancer (χ22 = 0.25; P = .62).

In this cohort study of LCS-screened individuals, cancer survivors were more likely to be older and formerly smoked and had slightly more comorbidities compared with individuals without prior cancer. Although rates of positive LDCT findings were similar, these findings suggest that the lung CDR may be higher in cancer survivors vs those without prior cancer and should be evaluated in larger studies. The complex relationship between cancer survivorship and the risk of second primary lung cancer underscores both the challenges and the opportunities for preventive care, such as LCS, in this population.