ArticleThe Lancet regional health. Western Pacific2026
Stage shifts in national lung adenocarcinoma and the impact of opportunistic self-initiated LDCT screening in Taiwan: a nationwide population-based cohort study.
Article in The Lancet regional health. Western Pacific, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Lung cancer in Taiwan is never-smoking and adenocarcinoma (LUAD) predominant. This study evaluated national LUAD stage-shifts and their association with opportunistic, self-initiated low-dose computed tomography (LDCT) screening. Methods: A retrospective study was conducted using Taiwan Cancer Registry (TCR) data (2011-2023), and self-initiated LDCT screening records from five medical centers (2011-2021). Patients were classified as early-stage (stage I) and late-stage (stage II-IV). Outcomes included age-standardized incidence rate (ASIR), age-standardized incidence-based mortality (ASIBM), and average annual percentage change (AAPC) of national LUAD, and screening volume of self-initiated LDCT. Findings: Among 126,753 LUAD cases 71,159 (56.1%) were females and 87,830 (69.3%) never smoked. The opportunistic self-initiated LDCT screening revealed 70,803 individuals, most never smoked (83.7%) and were male (56.6%). ASIRs of stage 0 (AAPC, 49.6%; 95% confidence interval [CI], 43.3-71.0) and early-stage (AAPC, 13.0%; 95% CI, 12.3-13.7) increased significantly. Conversely, late-stage ASIRs declined in selected subgroups, including never-smoking females aged <55 years (AAPC, -1.9%; 95% CI, -0.3 to -0.9) and in smoking patients aged ≥75 years (males AAPC, -2.3%; 95% CI, -3.1 to -1.5; females AAPC, -3.9%; 95% CI, -6.3 to -1.3). Rising LDCT screening volume descriptively paralleled this stage-shift in never-smoking females. ASIBM declined significantly over time, particularly in advanced-stage disease. Interpretation: The coexistence of increasing early-stage incidence, largely stable late-stage disease, and declining incidence-based mortality suggests a transition phase characterized by both detection expansion and emerging clinical benefit. The increase in self-initiated LDCT screenings paralleled the stage-shift among never-smoking females, and further research is needed to assess long-term outcomes and cost-effectiveness. Funding: Health Promotion Administration, Ministry of Health and Welfare; the Ministry of Health and Welfare and Formatting the Risk Prediction Models for Never-Smoking Lung Cancer (FORMOSA).
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