Are There Gender Disparities in Lung Cancer Screening Outcomes Among People Who Have Never Smoked?

Individuals with no history of smoking who received low-dose computed tomography (LDCT) screening showed no significant sex-based differences in lung cancer diagnoses, stage distribution, or lung cancer–specific deaths, according to results from a recent study performed by a team of researchers from South Korea.

The study, which was published in JAMA Network Open, sought to explore gender-based differences in lung cancer screening outcomes, as well as potential susceptibility to overdiagnosis, among men and women of Asian descent who had no history of smoking.

Due to the rise in lung cancer diagnoses among individuals who have never smoked in East Asia, opportunistic LDCT screening has increased in popularity. However, the study outlined that there is little evidence supporting the need for lung cancer screening within this population.

Furthermore, the researchers explained that “women typically engage more often with medical care and undergo opportunistic screening more frequently,” leading to an increase in overdiagnosis of indolent cancers in women compared with men.

The multicenter study was performed at health checkup centers in South Korea between 2009 and 2021. Eligible participants included patients between 50 and 80 years old who had no history of smoking and received LDCT lung cancer screening, and a total of 21,062 patients were enrolled in the study. The researchers retrospectively analyzed the data from November 2023 to June 2024 and followed up with participants until December 2022.

Of the total participants, 16,133 were women (76.6%) and 4,929 were men (23.4%). A total of 176 patients (139 women [0.9%] and 37 men [0.8%]) were diagnosed with lung cancer after receiving screening.

When broken down further by sex, the data demonstrated that 131 of 139 women (94.3%) were diagnosed with stage 0 to stage 1 lung cancer, compared with 33 of 37 men (89.2%). In addition, the findings showed “no significant sex-based differences in stage or histologic type distribution.”

Among the entire screened cohort of 21,062 patients, LCSD was found in eight women and three men at the mean follow-up point of 83.8 months. The researchers found “no significant association between sex and cumulative hazards “of lung cancer diagnosis (adjusted hazard ratio [aHR], 0.90 [95% CI, 0.64-1.26] for men vs women) or lung cancer–specific deaths (aHR, 1.06 [95% CI, 0.28-4.00] for men vs women) after conducting a multivariable analysis.

Moreover, the 5-year lung cancer-specific survival rate was found to be 100% for men versus 97.7% for women, among individuals whose cancer was detected via screening, which demonstrated no significant differences between the sexes.

The results illustrated that among Asian patients with no smoking history who received LDCT screening, there were no gender or sex-based disparities in lung cancer diagnosis, stage distribution, or lung cancer–specific deaths. Furthermore, the investigators concluded that “these findings suggest that men and women who have never smoked would experience similar risks of overdiagnosis with little to no benefit when exposed to indiscriminate screening.”

Source: JAMA Network Open