Early detection of lung cancer: The past, present, and future

Lung cancer remains the leading cause of cancer-related deaths in Canada, primarily due to late-stage diagnoses. While the 5-year survival rate is 69%–82% for stage I disease, it drops sharply to 21%–44% for stage III, and 7%–18% for stage IV. To address this public health crisis, this review examines the evolution and implementation of Canadian lung cancer screening programs. Landmark clinical trials, including the National Lung Screening Trial (NLST) and the Dutch–Belgian lung cancer screening trial (Nederlands–Leuvens Longkanker Screenings Onderzoek [NELSON]) have unequivocally demonstrated that screening with low-dose computed tomography (LDCT) significantly reduces mortality. Presently, all 10 Canadian provinces are advancing organized screening programs utilizing the PLCOm2012 risk prediction model. However, significant systemic gaps persist. Current eligibility criteria rely heavily on smoking history, inadvertently excluding individuals who have never smoked—a demographic accounting for nearly one-quarter of all lung cancer cases. This exclusion disproportionately affects women of South and East Asian descent. Furthermore, geographic barriers limit access for isolated rural populations, and current screening guidelines lack consensus regarding survivors of non-pulmonary primary cancers. To mitigate these limitations, this review explores emerging early detection modalities, including the systematic management of incidental pulmonary nodules, breathomics, and artificial intelligence. Finally, it emphasizes the pivotal role of oncology nurses in patient advocacy, radon education, and tobacco cessation to maximize screening efficacy and ensure equitable access for all Canadians.