Young, fit non-smoker had lung cancer: Why screening can miss patients

When Rasika Bombatkar developed a persistent cough during the monsoon season four years ago, her doctors initially dismissed her concerns. At just 34 years old and a non-smoker, she did not fit the typical profile of a lung cancer patient. It wasn't until a TB awareness campaign featuring actor Amitabh Bachchan prompted her to ask for a CT scan that doctors finally diagnosed her with late-stage lung cancer.

"I was lucky to be an allied health professional," Bombatkar explained, "I could research and insist on the test at my workplace." Despite having a clear CT scan result, the cancer had already spread to her lymph nodes when doctors reviewed it. This story, shared at the World Cancer Congress in Hong Kong, highlights a significant challenge in early lung cancer detection: conventional screening criteria often overlook non-smokers and younger patients.

While medical literature suggests lung cancer typically affects older, long-term smokers, the reality is that people like Bombatkar can develop the disease too. The International Agency for Research on Cancer (IARC) warns that low-dose CT scans for lung cancer screening, which could improve survival odds, also increase the risk of other cancers due to radiation exposure.

As such, the LDCT test is only recommended for high-risk individuals aged 50-80 with a long smoking history. Bombatkar's experience illustrates the need for healthcare providers to reconsider such rigid guidelines when symptoms arise. Lung cancer is often diagnosed too late, when treatment becomes less effective and survival rates drop.

In India, it was the third most common cancer in 2024, affecting 112,000 people and killing over 98,000, according to Global Cancer Observatory data. A study found that nearly 45% of patients were diagnosed after the disease had spread, underscoring the necessity of stronger prevention and early detection measures. However, implementing a national screening programme in India poses challenges, with the current low-dose CT scan tool being costly and unevenly available.

While screening has been effective in high-risk smokers in Australia, the situation in Asia differs, with a large number of lung cancer cases among non-smokers, including those with a family history. Hong Kong is currently investigating whether lung cancer screening could benefit high-risk non-smokers, including those with a family history.

Emerging risk-prediction models may help identify individuals outside traditional screening criteria, potentially expanding the approach with the help of technologies such as AI-based chest X-rays. Nonetheless, researchers like Dr. Abhishek Shankar of AIIMS in Delhi are exploring additional risk factors, including pollution exposure, to better understand and target lung cancer cases.