Beyond lung cancer

Health systems are under growing strain as populations age and chronic diseases rise. The challenge is no longer simply how to treat illness, but how to detect it earlier and manage it more efficiently. Lung cancer screening offers a useful lens through which to consider this shift – not only for improving cancer outcomes, but for how health systems might evolve to be more resilient.

This is why screening programmes – which enable early detection of conditions when interventions are most effective – are such a vital tool in ensuring that health system resources are used effectively.

Traditional models of cancer screening typically centre on one specific cancer at a time. For lung cancer, low-dose computed tomography (LDCT) offers a structured pathway to detect it in high-risk populations. This approach could serve as a blueprint for countries to establish a more proactive and integrated approach to screening for NCDs; these approaches could draw on learnings from lung cancer screening programmes to understand how best to future‑proof health systems against growing demand.
 

The implementation gap: strong evidence, limited uptake

The case for implementing LDCT screening for lung cancer is already strong, but adoption remains limited: a mere 14 countries worldwide have established screening programmes. As a result, 70% of lung cancer cases continue to be detected at a late stage, when people face limited treatment options and lower rates of survival.

Detecting lung cancer earlier changes this trajectory. When diagnosed at stage I, five-year survival exceeds 80%, compared with just 7–18% for people diagnosed at stage IV.  Screening not only improves outcomes but can also reduce the cost of treatment by shifting care towards earlier intervention. It also provides an important opportunity to engage people in smoking-cessation programmes.

In short, targeted LDCT screening is one of the few interventions that can simultaneously improve outcomes, reduce long-term costs and strengthen risk reduction efforts. For countries with sufficient resources, implementing such programmes should be a priority.
 

Beyond single-disease screening: a more integrated approach

Once established, LDCT screening programmes for lung cancer could evolve beyond detecting this disease alone. By identifying high-risk populations and creating regular points of contact with the health system, these programmes offer a ready-made platform for more integrated approaches to care.

One area of growing interest is the potential to screen for multiple conditions with shared risk factors. Lung cancer, chronic obstructive pulmonary disease and cardiovascular disease – sometimes referred to as ‘the big three’ – can coexist and are driven by common risk factors (such as tobacco smoking). Early research suggests that LDCT scans could be used to identify indicators of these conditions, such as coronary artery calcification, alongside lung nodules.

From a systems perspective, this approach could improve efficiency by identifying multiple conditions through a single interaction, rather than through separate screening programmes. It could also help shift care towards earlier intervention across a broader set of diseases.

However, important questions remain. Evidence on the effectiveness of combined screening is still emerging. There are also considerations around patient experience and preference: being screened for multiple conditions at once may increase anxiety, and the risk of overdiagnosis or false-positive results must be carefully managed.

For now, the priority for countries with established LDCT programmes for lung cancer should be to generate robust evidence exploring the opportunity of combined screening. This could be a chance to assess any challenges with implementation and balance the benefits and risks of combined screening.
 

What comes next: emerging methods for multi-cancer detection

Looking further ahead, new technologies could expand this approach. Multi-cancer screening – which analyses certain markers in the blood, urine, stool or breath – aims to identify different types of cancer with a single test. For lung cancer, these approaches are primarily used to complement LDCT screening and support treatment selection.

Such tests could offer several advantages. They could be easier to deliver – even in the community – and less expensive than other image-based screening approaches, which would facilitate access.

But research is still in its infancy. Sensitivity in detecting cancer at an early stage is variable, and it is not yet entirely clear whether these approaches are suitable for national programmes. As with combined screening, further research and data are needed to fully understand their role, limitations and potential impact on health systems.
 

From screening to system strategy

LDCT screening is not just a tool to detect lung cancer, it could also be a platform for rethinking how health systems detect and manage chronic disease.

Detecting conditions at a stage when treatments are most effective and least costly is essential. There is potential to leverage the strong evidence base for LDCT screening programmes for lung cancer and use these established touchpoints with the health system to screen for other NCDs, if sufficient evidence is collected to support expansion.

The lesson is not simply that screening works. It is that well-designed screening pathways can become a foundation for more integrated, efficient and resilient health systems that are better equipped to respond to the growing challenge of chronic disease.