Lung cancer screening in Asians and Asian Americans Who Have Never Smoked: A Scoping Review

Abstract

Introduction: A growing trend of lung cancer diagnoses is occurring among Asians and Asian Americans who have never smoked, driving increased interest in implementing lung cancer screening (LCS) in this population. Current data, however, remain insufficient to support such efforts. This scoping review summarizes studies evaluating LCS using low dose computed tomography (LDCT) among Asians and Asian American nonsmokers, reporting lung cancer detection rates and highlighting the heterogeneity across studies that limits the generalizability of results.

Method: A scoping review was conducted of studies from East Asia and the United States that utilized LDCT to screen for lung cancer among Asians and Asian Americans or a subset of these populations. Data on study design, screening eligibility criteria, screening protocols, and primary outcomes, including lung cancer detection rates and stages, were extracted and summarized descriptively.

Results: A total of 1,334 studies published during 2003–2025 were identified. Of these, 28 met inclusion criteria and originated from Taiwan, Korea, Japan, China, and the United States. Among eight studies that included only Asian and Asian American individuals, four were prospective and four were retrospective. Twenty studies which included both smokers and Asian and Asian American participants were comprised of one randomized control trial, nine prospective, and ten retrospective studies. Substantial variation was observed in definitions of smoking status, screening eligibility criteria (including age thresholds), LDCT protocols, and nodule reporting and follow-up practices. Among the 28 studies, 24 reported lung cancer detection rates in the range of 0.05–4.1% among Asians and Asian Americans who had never smoked.

Conclusions: Although several studies have evaluated LCS using LDCT in Asians and Asian Americans who have never smoked, marked heterogeneity across study designs and protocols limits the ability to synthesize findings or draw meaningful conclusions. This review underscores these gaps and may inform the design and focus of future studies to guide evidence-based LCS recommendations for this population.