Lung cancer kills more people in Canada than breast, colorectal, and cervical cancers combined. Yet it remains the cancer we screen for the least. A new study published in the Journal of the American Medical Association shows how costly that practice has become, both in lives lost and in public dollars spent.1
The researchers modeled what would happen if lung cancer screening were offered to the general population solely based on age. They found that universal age-based screening for people ages 40 to 85 could prevent 62,000 deaths over 5 years in the United States. The cost per life saved was roughly $101,000 USD.
For comparison, breast cancer screening costs $890,000 USD per life saved, and colorectal screening costs $920,000 USD. In other words, lung cancer screening is not only lifesaving but also dramatically more cost-effective than the tests we already treat as routine.
These findings should force us to reconsider who is offered the chance to detect cancer early. Survival rates for stage I lung cancer have quietly undergone a transformation. The Early Lung Cancer Action Program now reports an 80% survival rate at 10 years for patients whose cancer is found at stage I.2 That is a striking improvement over the widely quoted 65% at 5 years. Early detection prevents progression. Once lung cancer advances, the odds collapse.
The biology of the disease adds urgency. The lungs are large organs with no pain receptors. Symptoms usually only appear after the cancer has already spread. As a result, more than half of all lung cancers are discovered at stage IV, long after the window for curative treatment has closed. Screening is the only tool that can reliably change this pattern.
For decades, the slow adoption of lung screening has been shaped as much by stigma as by science. Lung cancer is the only major cancer where patients often feel blamed for their illness. The 2023 Global Lung Cancer Coalition found that 40% of respondents felt less sympathy for people with lung cancer than for those with other cancers, a belief that continues to influence everything from research funding to screening policies.3
Stigma has depressed investment in research and contributed to reluctance among both physicians and patients to pursue early detection. Yet nearly 20% of people diagnosed with lung cancer today have never smoked. Many of them are younger women, a group that has seen a steady rise in cases.
Radon exposure, wildfire smoke, and air pollution may be driving these diagnoses. When stigma replaces empathy, people are diagnosed too late, and the result is unnecessary suffering that no other cancer population is asked to endure.
Canada’s experience also underscores the financial consequences of late discovery. A recent Canadian study published in the Journal of Thoracic Surgery found that the annual cost of treating a patient with stage I lung cancer is about $15,000 CAD.4 For patients with stage IV lung cancer, health care costs rise to $170,000 CAD.
Despite these stark differences, only about 30% of lung cancers are diagnosed at stage I, while more than 50% are diagnosed at stage IV. A detection stage shift would save millions in health care spending and, more importantly, prevent immense suffering for patients and families.
Canada launched its first early detection program in British Columbia in 2022, and similar programs are now emerging across the country. Eligibility is determined by the PLCOm2012 model, which considers age, smoking history, sex, and race.
This approach improves precision for high-risk patients who smoke; however, it excludes a rapidly growing group of people without a smoking history, which has created deep frustration among patients who never had the opportunity for screening and now face late-stage diagnoses.
For patients like Sarah Glen, a resident of Vernon, British Columbia, Canada, and mother of one, the argument that screening causes unnecessary worry rings hollow. Her cancer was discovered at age 47 when it had already spread to her bones and brain.
Reflecting on the possibility of an earlier detection, she said, “If someone had offered me a screening test at 40, I would have taken it without hesitation. A mild dose of radiation or a false positive would have been a small price to pay to evade the awful outcomes of stage IV cancer.”
Canada has set an ambitious goal. The new Pan-Canadian Lung Cancer Action Plan aims to reduce mortality by 30% by 2035.5 Early detection is identified as a key strategy for meeting that target. Christian Finley, MD, MHP, FRCSC, a thoracic surgeon and co-chair of the national committee behind the plan, underscored the implications of the new evidence.
“We screen for cancers that are far less lethal and far more expensive to treat. This study adds to the growing evidence that detecting lung cancer earlier saves lives, and that we need new ways to reach the many people who don’t fit the traditional risk profile,” Dr. Finley said.
As we already accept the value of breast, colorectal, and cervical cancer screening in the general population, it is difficult to defend the continued exclusion of lung screening. Anyone with lungs is at risk for lung cancer. The science is clear. The economics are compelling. And the human toll of late diagnosis is overwhelming.
If we are serious about saving lives from lung cancer, universal age-based screening should be treated not as a radical proposal but as the overdue next step.
References:
- 1. Yang HC, Chang A, Visa M, et al. Age-Based Screening for Lung Cancer Surveillance in the US. JAMA Netw Open. 2025;8(11):e2546222. doi:10.1001/jamanetworkopen.2025.46222
- 2. Henschke CI, Yip R, Shaham D, Markowitz S, Cervera Deval J, Zulueta JJ, Seijo LM, Aylesworth C, Klingler K, Andaz S, Chin C, Smith JP, Taioli E, Altorki N, Flores RM, Yankelevitz DF; International Early Lung Cancer Action Program Investigators. A 20-year Follow-up of the International Early Lung Cancer Action Program (I-ELCAP). Radiology. 2023 Nov;309(2):e231988. doi: 10.1148/radiol.231988. PMID: 37934099; PMCID: PMC10698500.
- 3. Symptom awareness, attitudes to lung cancer and views on screening 2023/24
- 4. P3.01.24 Economic Burden of Radon Attributable Non-Small Cell Lung Cancer: A Cost Analysis. Griffin, D. et al. Journal of Thoracic Oncology, Volume 20, Issue 10, S412
- 5. 2026-2035 Pan-Canadian Lung Cancer Action Plan
