Lung Cancer · Nov 2026
Lung cancer detection beyond screening eligibility through an incidental lung nodule program
By Wang HY, Cascio CL, Qi J et al.
Purpose Lung cancer screening has improved early detection among individuals who meet established age and smoking criteria. However, many patients who develop lung cancer remain ineligible for screening. Incidental pulmonary nodules (ILN) identified on imaging performed for other indications may provide important complementary pathway for early lung cancer detection, but the contribution of structured ILN programs to cancer detection outside conventional screening eligibility remains incompletely characterized. Methods We retrospectively analyzed prospectively collected data from two urban academic hospitals from January 2023 through January 4, 2026. Patients with ILN requiring surveillance were identified using natural language processing of radiology reports and navigator review. Screening eligibility was classified according to 2021 United States Preventive Services Task Force criteria. Cancer detection, stage, histology, treatment, and factors associated with cancer among screening-ineligible patients were evaluated. Results Among 2,804 patients requiring follow-up, 2,248 (80.2 %) were screening ineligible, 466 (16.6 %) eligible, and 90 (3.2 %) unclassified. Lung cancer was diagnosed in 73 patients (2.6 %), including 44 (60.3 %) who were screening ineligible. Of these, 15 were never-smokers and 29 were former or current smokers who did not meet screening criteria. Thirty-six (81.8 %) had stage 0-II disease, 21 (47.7 %) underwent definitive surgical resection, and 36 (81.8 %) had adenocarcinoma. Nodule diameter > 8 mm was associated with lung cancer diagnosis (adjusted odds ratio 15.89; 95 % CI 5.24–71.47). Conclusions The ILN program identified substantial early-stage, clinically actionable lung cancers among patients outside conventional screening eligibility. The high proportion of early-stage diagnoses and definitive resections supports ILN programs as a complementary pathway to organized lung cancer screening.