Abstract
Lung cancer remains the leading cause of cancer-related deaths in China. Optimizing lung cancer screening strategies to improve screening efficiency and mitigate associated harms has become a key research focus and priority in current clinical practice. The purpose of this paper is to revise the China national lung cancer screening guideline with low-dose computed tomography (LDCT) (2023 version). The revision work for the 2025 version of this guideline was jointly undertaken by experts from the Chinese Expert Group on Early Diagnosis and Treatment of Lung Cancer and experts from the China Lung Oncology Group. Drawing on recent advances in LDCT lung cancer screening at home and abroad, combined with the epidemiological characteristics of lung cancer in China, the expert panel revised the guideline with the following key updates: (1) In the selection criteria of high-risk population, the exposure duration to occupational lung carcinogens is clearly specified; additionally, if an individual's physical condition cannot tolerate potential lung cancer resection surgery or the individual suffers from a life-threatening disease during annual screening, discontinuation of LDCT screening is recommended. (2) The method for measuring nodule size is updated, with mean diameter adopted as the metric for assessing nodule size. (3) In nodule management, the positive threshold for the mean diameter of solid nodules or the solid components of part-solid nodules in baseline screening is raised to 6 mm, and the follow-up interval for positive solid or part-solid nodules is adjusted from 6 months to 3-6 months. (4) It is recommended that informed consent and shared decision-making be integrated throughout the entire process, including high-risk group identification, screening interval determination, and nodule management. This revision further clarifies and optimizes the selection of high-risk groups and the management of screen-detected nodules. Based on a comprehensive balance between the benefits and potential harms of lung cancer screening, it emphasizes the critical importance of informed consent and shared decision-making. This revised guideline will be more aligned with China's national conditions and enhance the standardization and applicability of LDCT-based lung cancer screening across the country.
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