Why Never-Smoking Asian Women Skip Annual Lung Cancer Screening

LUNG cancer screening earns strong endorsement from high-risk, never-smoking Asian American women, but few plan annual scans. In a survey of women who had already completed low-dose CT (LDCT), nearly all would recommend the test, yet only a small minority intended to repeat it each year.

Rising Risk Outside Screening Guidelines

Lung cancer is the leading cause of mortality among Asian Americans. Despite a low prevalence of smoking, never-smoking Asian American women are more than twice as likely to develop lung cancer as their racial counterparts. While overall U.S. lung cancer rates are declining, incidence in this group is increasing. Current LDCT screening guidelines require a smoking history for eligibility, so these women are not considered high-risk and are excluded from routine lung cancer screening.

Lung Cancer Screening Experience and Intentions

Researchers surveyed 227 Asian American women aged 50 years and older with a family history of lung cancer, all of whom had completed LDCT through a Northern California screening program between September 2025 and April 2026. The cohort was 53% Chinese, 19% Southeast Asian, 15% East Asian, and 13% other or mixed race, with a mean age of 62.8 years.

Overall, 92.5% reported a positive screening experience and 96.4% would recommend LDCT to others. However, only 6.0% intended to undergo annual screening themselves. More than half (53.1%) reported barriers, and 80% of concerned respondents cited radiation exposure. Knowing someone with lung cancer influenced decisions for 86.5% of participants. Only 10.2% worried about developing lung cancer. Results did not differ significantly across Asian American ethnic subgroups.

Care Team Trust Reduces Worry

A positive prior screening experience was associated with reduced odds of worry about lung cancer (OR: 0.067; 95% CI: 0.007 to 0.70). Trust in physicians, institutions, and government was not significantly associated with worry, but greater trust in the broader care team was (OR: 0.101; 95% CI: 0.001 to 0.967). Annual screening remained low because of concerns about radiation exposure, insurance coverage, and cost.

Closing the Gap in Clinical Practice

The findings point to two strategies for clinicians. Educating Asian American women about the minimal radiation exposure of LDCT addresses the most common concern. Empowering the wider multidisciplinary team, including patient navigators, to build trust and respond directly to concerns about cost and coverage may help turn general endorsement into sustained annual lung cancer screening.

Reference
Nelluri S et al. Novel perceptions from the California Lung Cancer Screening Trial: the gap between endorsement and intention in high-risk, never-smoking Asian American women. CHEST Annual Meeting, October 18-21, 2026.

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