Identifying which never-smokers face high lung cancer risk presents a major challenge for health systems, contributing to disparities that hit some populations harder than others. Lung cancer in individuals who have never smoked accounts for 10% to 25% of all cases and ranks as the fifth leading cause of cancer death globally, yet screening programs struggle to pinpoint at-risk individuals without smoking history.
The disease affects East Asian women at particularly high rates, exposing significant racial health disparities. Risk factors like secondhand smoke, air pollution, radon exposure, and genetic susceptibility vary widely across communities, making uniform screening criteria ineffective. Researchers note these exposures create conditions that promote cancer development, but determining individual risk levels remains difficult.
Current screening approaches were designed for smokers, leaving health systems without clear guidelines for never-smoker populations. While low-dose CT screening can detect early-stage disease, widespread application in groups without traditional risk factors raises concerns about unnecessary interventions and radiation exposure. Mortality benefits for screening never-smokers have not yet been demonstrated.
The challenge intensifies because lung cancer in never-smokers exhibits distinct biological characteristics, including higher rates of EGFR, ALK, and ROS1 mutations that are especially common in Asian populations. Without smoking history as a straightforward risk indicator, clinicians lack tools to determine who needs screening.
Future strategies must integrate demographic, clinical, genetic, and environmental data—potentially with artificial intelligence support—to better identify high-risk never-smokers. Until such approaches exist, screening programs risk missing vulnerable populations while over-screening others, perpetuating health disparities.
See: “CT Screening Challenges Amid Rising Threat of Lung Cancer in Individuals Who Have Never Smoked” (January 27, 2026)Â
