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Lung cancer remains the leading cause of cancer death worldwide, with nearly 1.9 million deaths reported in 2024. A new review by the International Agency for Research on Cancer (IARC) has found that low-dose computed tomography (LDCT) screening can reduce lung cancer mortality among people at high risk while also reducing the occurrence of late-stage disease.

The findings come from IARC Handbooks of Cancer Prevention Volume 21, which assessed the benefits and potential harms of lung cancer screening. The IARC Working Group concluded that LDCT has established evidence for reducing deaths from lung cancer in high-risk populations. The review was published as a special report in The New England Journal of Medicine on September 24, 2026.

LDCT uses computed tomography to obtain detailed images of the lungs while using a lower radiation dose than a conventional diagnostic chest CT. Its role in screening is to identify lung cancer at an earlier stage, when treatment may be more effective. IARC considers screening a complementary measure to primary prevention, particularly tobacco control, rather than a replacement for preventing tobacco exposure. The IARC review found that the evidence supporting LDCT is specifically related to people at high risk of lung cancer. This distinction is important because the evidence does not mean that routine LDCT screening should be offered to every individual. Screening programmes need to identify people who are sufficiently at risk to benefit from screening while limiting unnecessary investigations and potential harms.

The findings also raise an important question for India: how should lung cancer screening be designed for the country's own population and healthcare system? AIIMS New Delhi has been involved in research examining the feasibility of lung cancer screening in developing countries, including the challenges and opportunities associated with implementing screening programmes. The AIIMS Department of Pulmonary, Critical Care & Sleep Medicine also operates dedicated lung cancer services and has an active research focus in respiratory disease and thoracic oncology.

Developing local evidence is particularly relevant because lung cancer risk patterns, smoking exposure, environmental exposures and access to diagnosis and treatment can differ between countries. An effective screening programme therefore requires more than access to CT scanners; it also needs appropriate risk assessment, interpretation of lung nodules, diagnostic follow-up and access to cancer treatment. IARC's assessment also considered potential harms associated with screening. These include false-positive findings, unnecessary diagnostic procedures and overdiagnosis. As a result, screening needs to be organised within a healthcare pathway that can appropriately evaluate abnormal findings and provide follow-up care.

AIIMS' cancer services similarly emphasise early detection, risk assessment and follow-up as components of cancer control. Its Preventive Oncology department focuses on cancer prevention and early detection, particularly among populations at increased risk.

Despite the potential role of screening, IARC continues to identify tobacco smoking as the principal risk factor for lung cancer, accounting for approximately 85% of cases. Other exposures include second-hand tobacco smoke, outdoor and indoor air pollution, diesel engine exhaust, welding fumes and asbestos. Therefore, reducing tobacco use remains a major component of lung cancer prevention. The latest IARC assessment strengthens the evidence for LDCT as a lung cancer screening tool for appropriately selected high-risk populations. For India, the next step involves generating locally relevant evidence and developing screening pathways that connect risk assessment and LDCT with timely diagnosis, treatment, and follow-up.

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