The Ministry of Health and Welfare is revising the national lung cancer screening guidelines to expand the target population and aims to implement these changes in the first half of next year.

However, the ministry emphasized that it needs clear evidence to justify expanding the target group.

Jang Jae-won, director of the ministry’s Disease Policy Division, made these points while attending the “Policy Discussion on the Strengths of Korea's Lung Cancer Management System and Directions for Improving the Screening System,” held at the National Assembly on Tuesday and organized by Rep. Suh Myeong-ok of the People Power Party.

Since 2019, Korea has used low-dose chest CT scans to screen high-risk groups for lung cancer every two years. Eligible groups include people aged 55 to 74 and smokers with a 30-pack-year history. The screening participation rate has grown from 20 percent in the first year to about 50 percent recently.

As the proportion of patients diagnosed with lung cancer at an early stage through low-dose CT screening has increased, the early diagnosis rate has risen from below 15 percent to around 60 percent among national screening participants. Furthermore, the five-year relative survival rate for lung cancer patients detected through the national screening program exceeds 80 percent, demonstrating the program's effectiveness.

In this context, Director Jang stated that the ministry is expanding the screening target population by revising the “National Lung Cancer Screening Guidelines,” aiming to complete this process in the first half of next year. However, he emphasized that revising the guidelines requires crucial “evidence.”

Jang said, “Expanding the lung cancer screening target population was a key point at the briefing. Ten years have passed since the 2015 guidelines, so a review is needed. However, expanding screening or increasing support requires substantiating the evidence to justify budget allocation.”

He further explained, “To revise the guidelines, a relevant committee was established at the National Cancer Center in April, with experts from related academic societies participating in discussions. The review process is comprehensively examining age criteria, screening intervals, and expanding the target population. While nothing is finalized yet, as it's ongoing, internally, we aim to prepare the revised guidelines by the first half of next year.”

Regarding lung cancer screening for non-smokers, he noted that the “evidence is still weak.” To address this, he said, “We plan to conduct research at the national level, linking national screening data and other resources, to identify lung cancer risk factors beyond smoking.”

At the forum, Legislative Researcher Kim Eun-jeong from the National Assembly Research Service presented on “Achievements and Future Direction of the National Cancer Control Plan,” proposing expanded screening targets and diversified screening methods.

Kim said, "As the world's first national program to standardize high-risk groups and verify effectiveness and safety, it is recognized internationally. Clear outcomes, such as lower mortality, earlier diagnoses, and better survival rates, continue to be seen."

However, Kim also pointed out some limitations. Only about 30 percent of lung cancer patients are covered by the national screening program. Low-dose chest CT has clinical drawbacks, such as false positives and overdiagnosis among non-smokers and women. Participation is also low in underserved areas, among low-income groups, people with chronic conditions, and multicultural families, making social equity a challenge.

Accordingly, she proposed improvements for inclusion in the “5th National Cancer Control Plan,” effective from 2026 to 2030.

First, Kim stated that quality management of screening must be strengthened by introducing innovative technologies, such as big data for cancer patients and integrated genomic–clinical precision diagnostics, establishing standard protocols for image interpretation, and implementing AI-assisted diagnostic systems.

She emphasized establishing new screening criteria for blind spots—such as smokers with less than 30 pack-years, individuals over 74 years old, and non-smoking women—to broaden eligibility for low-dose chest CT screening.

Professor Um Sang-won from Samsung Medical Center, who presented on “Current Status and Limitations of Lung Cancer Screening Accessibility and Post-Screening Management,” echoed the call to broaden the target population for lung cancer screening.

He noted, “Participation in national lung cancer screening is not yet perfect, but we must aim for 100%. Screening faces regional accessibility issues. Island regions and rural and fishing villages have limited access to medical institutions. While screening costs are low, actual costs rise due to transportation and other factors.”

Um also shared that about 36 percent of lung cancer patients in Korea are non-smokers. He highlighted the absence of national screening for this group as a major problem. He noted ongoing discussions to increase the screening age and reduce smoking exposure criteria but emphasized that screening non-smokers should also be considered.

Professor Um said, “While the United States does not recommend lung cancer screening for non-smokers, studies conducted in the U.S. have included very few Asian subjects. Therefore, using this as a basis to recommend against non-smoker screening in Korea is inappropriate. We need a model tailored to Korea.”