Innovative approaches for lung cancer screening and interception.

This review article addresses why lung cancer remains the leading cause of cancer death and focuses on improving early detection and interception of disease.

Key points:

• Current state of screening
  • Low-dose CT (LDCT) screening lowers lung cancer mortality in high‑risk populations defined by age and smoking history.
  • Despite proven benefit, real‑world uptake of LDCT among eligible people is low.
  • Modeling suggests that about half of lung cancers arise in individuals who do not meet existing LDCT eligibility criteria, leaving a large gap in early detection.
• Limitations of LDCT
  • High false‑positive rates lead to additional imaging, invasive procedures, anxiety, and potential harm.
  • Cost and infrastructure demands limit wide‑scale adoption and sustainability.
  • These issues underscore the need for more precise risk stratification and more efficient screening pathways.
• Emerging biomarkers and risk prediction
  • Research is focused on:
    • Radiomic features from imaging to better characterize nodules and individual risk.
    • Liquid biopsy approaches (e.g., blood-based assays) to detect molecular signatures associated with lung cancer or high‑risk states.
  • The goal is to refine who should be screened, reduce unnecessary follow‑up, and improve early detection beyond current age/smoking‑based criteria.
• Nodule management and precancer interception
  • Increasing use of LDCT and diagnostic CT has led to more incidental pulmonary nodule detection.
  • The review emphasizes strategies to:
    • Distinguish indolent from high‑risk precancerous or early lesions.
    • Develop therapeutic interventions that “intercept” high‑risk nodules before they progress to invasive cancer.
• Disparities and implementation
  • The article highlights disparities in access, uptake, and outcomes in lung cancer screening.
  • It discusses infrastructural and system-level requirements for optimal implementation, including workforce, access to imaging, and integration into health systems.
• Future directions
  • Integration of clinical factors, imaging, and molecular biomarkers into more accurate risk models.
  • Designing and testing interception strategies for premalignant and very early lesions.
  • Policy and implementation efforts to broaden appropriate access to screening while minimizing harm and cost.

Overall, the review synthesizes current evidence on lung cancer screening, outlines where existing strategies fall short, and describes biomarker-driven and interception-based approaches that could shift lung cancer control toward more effective prevention and earlier, less morbid intervention.