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LDCT uptake and determinants of lung cancer screening in Asia: a systematic review and meta-analysis
Yue Hu1,2, Yuntong Zhao1,2, Pei Dong1
1Institute of Medical Information & Library, Chinese Academy of Medical Sciences, Beijing, China.
Importance:
Low-dose computed tomography (LDCT) lung cancer screening (LCS) has been shown to significantly reduce mortality rates. As its effectiveness relies on LDCT uptake, understanding uptake rates and their determinants can enhance the implementation and effectiveness of screening programs.
Objective:
This study aimed to analyze LDCT uptake and its influencing factors in lung cancer screening within an Asian population.
Methods:
Studies published between 1 January 2011 and 31 October 2025 were retrieved from four databases, and those reporting LDCT uptake and/or the factors influencing it were included. A random-effects model was applied to combine the effect estimates and 95% confidence intervals. Subgroup analyses were conducted to explore heterogeneity.
Results:
A total of 35 studies involving 1,716,756 participants were analyzed, yielding a pooled LDCT uptake rate for lung cancer screening of 46% (95% confidence interval [CI], 41-51%). Program-level factors included sample scale, year of LDCT uptake, and program setting (p < 0.05). Patient-level factors that facilitated participation included a family history of lung cancer (odds ratio [OR], 1.95; 95%CI, 1.45-2.63), harmful occupational exposure (OR, 1.48; 95%CI, 1.33-1.64), chronic respiratory diseases (OR, 1.97; 95%CI, 1.62-2.38), alcohol consumption (OR, 1.20; 95%CI, 1.06-1.36), passive smoking exposure (OR, 1.43; 95%CI, 1.24-1.64), a higher body mass index (BMI; OR, 1.12; 95%CI, 1.05-1.20), and higher education levels (OR, 1.35; 95%CI, 1.17-1.56). Patient-level barriers included being a man (OR, 0.61; 95%CI, 0.55-0.68), engaging in frequent exercise (OR, 0.89; 95%CI, 0.84-0.94), smoking (OR, 0.76; 95%CI, 0.66-0.88), and being middle-aged (OR, 0.92; 95%CI, 0.85-0.99).
Conclusion:
LDCT uptake for lung cancer screening is lower in Asia than in academic programs, and it varies widely due to program design and population characteristics. Adopting smaller-scale screening designs and targeting key populations may help improve implementation efforts.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD42025641277, identifier CRD42025641277.
