Editorial: Increasing Awareness of Lung Cancer in Non-Smokers and Never-Smokers Challenges Current Approaches to Prevention and Screening

Lung cancer in never-smokers and in non-smokers accounts for between 15% and 25% of all lung cancers. Assumptions that lung cancer is almost always associated with cigarette smoking may delay diagnosis, treatment, and outcomes in non-smokers. The incidence of lung cancer in non-smokers is rising, especially in younger populations, presenting as adenocarcinoma with specific genetic mutations, and is associated with factors including air pollution and inhalation of second-hand tobacco smoke. In 2021, the United States Preventive Services Task Force (USPSTF) updated its 2013 lung cancer screening guidelines for low-dose computed tomography (LDCT) screening. However, the USPSTF still does not currently recommend lung cancer screening for non-smoking individuals. Therefore, age-based screening could improve cost-effectiveness and detection of lung cancer without missing diagnoses in women and never-smokers. Currently, only Taiwan has a national lung cancer screening program for early detection using LDCT in high-risk individuals. This editorial aims to highlight that non-smokers have risk factors for lung cancer that may challenge current criteria for inclusion in screening programs.