Lung Cancer Screening in Never-Smokers: a Balancing Act

Sir Muir Gray, the first Programme Director of the UK National Screening Committee, once said, "All screening programmes do harm; some do good as well, and, of these, some do more good than harm at reasonable cost".1 As demonstrated in the US National Lung Screening Trial (NLST)2 and the NELSON study,3 the so-called 'good' of low-dose CT (LDCT) screening for lung cancer is reduced lung cancer-specific mortality. Both studies recruited only people who had ever smoked, with thresholds of smoking intensity (eg, 30 pack-years for NLST) required for screening eligibility.