Rethinking Lung Cancer Screening: Expanding Access for Women, Nonsmokers

In this forward-looking conversation, Kim L. Sandler, MD, co-director of the Vanderbilt Lung Screening Program and associate professor of radiology and radiological sciences at Vanderbilt University Medical Center, shares her insights on the evolving challenges of lung cancer screening. Dr Sandler discusses the increasing incidence of lung cancer in people who have never smoked—particularly women—and emphasizes the need to re-evaluate who is eligible for screening. She also highlights current research focused on risk factors in women and the importance of incorporating lung health advocacy into existing preventive care, such as mammography.

The following transcript has been edited for clarity, style, and length.

Patient Care: Looking ahead three to five years, what do you think will be the greatest challenges in lung cancer and cancer screening?

Kim L. Sandler, MD: One of the biggest challenges will be identifying the ideal population for lung cancer screening. We've already seen one expansion of the guidelines—to include younger individuals and those with less tobacco exposure. But we're also seeing increasing rates of lung cancer in people who have never smoked, and currently, screening isn’t available to that group.

This is especially concerning among women. In fact, more than 50% of lung cancers in women worldwide occur in those who have never smoked. So we really need to determine where screening can be most effective and how to optimize the risk-benefit ratio for patients. While lung screening does have risks, including false positives, the potential to detect cancer early and save lives is significant—if we know who to screen.

There’s exciting research happening now that focuses specifically on women and lung cancer, particularly among those who have never smoked. We’ve seen a notably high prevalence in women of Asian descent, and there are studies examining familial patterns of lung cancer in never-smokers. While lung cancer affects both men and women, historically, it’s been viewed more as a disease of men. That perception needs to shift.

We also need to ensure women are aware of their risks. One effective strategy we've used is combining lung screening efforts with mammography. Women are typically very proactive about breast health, and we want to encourage that same level of advocacy for lung health.

For more of our conversation with Dr Sandler about her presentation given during the session, "Clinical Triad: Lung Cancer in 2025: A New Day Is Dawning," check out:

• Benefits of Lung Cancer Screening: A Conversation with Kim Sandler, MD
• Shared Decision-Making in Lung Cancer Screening: A Collaborative Approach
• Closing the Gap in Lung Cancer Screening: Overcoming Barriers, Improving Early Detection

For more 2025 ACP Internal Medicine Meeting coverage, please click here.