Chest X-Rays May Help Prevent Overdiagnosis in Lung Cancer Screening

Chest X-rays could play a key role in addressing the growing concern of overdiagnosis in lung cancer screening, particularly among Asian populations, according to new research published in Academic Radiology. As more individuals—including non-smokers—pursue low-dose CT (LDCT) screening, the detection of subsolid nodules has increased, raising concerns about unnecessary treatment and patient anxiety.

Fu-Zong Wu, MD, and colleagues from Kaohsiung Veterans General Hospital in Taiwan examined whether chest radiographs could serve as a triage tool to reduce unnecessary interventions. The team retrospectively analyzed over 500 lung cancer patients who had either undergone LDCT alone or LDCT in combination with a chest X-ray within three months of screening. Their goal was to assess differences in prognosis, recurrence, and the histopathologic makeup of lung adenocarcinoma confirmed via surgical pathology.

In the group that received LDCT alone, 37% of resected lesions turned out to be precancerous—classified as adenocarcinoma in situ or atypical adenomatous hyperplasia—suggesting overtreatment. By contrast, none of the subsolid nodules under 3 cm in the X-ray triage group were identified as precancerous. Despite this difference, there was no significant change in disease-free survival or relapse rates between the two groups.

These findings indicate that using chest X-rays as a triage step could help reduce overtreatment from LDCT screening without compromising patient outcomes. This is especially relevant in countries like China, Taiwan, and South Korea, where rates of early-stage lung cancer detection are rising and concerns about overdiagnosis are growing.

The researchers note that while a “stage shift” toward earlier cancer detection is a positive result of screening programs, it also brings the risk of identifying lesions that might never become clinically significant. As such, they advocate for a more nuanced screening approach that balances early detection with the potential harms of overdiagnosis and overtreatment.