Researchers show that refined lung cancer screening can save more lives – especially among long-term female smokers.
Low-dose CT scan of the lungs of a 69-year-old female smoker. The white, round area in the lung tissue indicates early-stage lung cancer. At this stage, lung cancer can still be treated effectively. Copyright: Charité/ Jens Vogel-Claussen
In order to reduce the high mortality rate from lung cancer, an early detection programme is to be introduced in Germany. It is aimed at people aged 50 and over who have been heavy smokers for a long time. A publication by Charité – Universitätsmedizin Berlin, Hannover Medical School (MHH), LungenClinic Grosshansdorf and the University Medical Centre Schleswig-Holstein (UKSH) now shows that if participants are selected not only on the basis of their age and smoking history, but also according to additional criteria, more cases of cancer can be detected at an early stage. As the research team describes in the journal The Lancet Oncology*, this is particularly relevant for women.
Every year, around 57,000 people in Germany are diagnosed with lung cancer – often with fatal consequences because the disease is typically detected too late. A new early detection programme is expected to start in April 2026, which will use computed tomography (CT) to check people at high risk of lung cancer for suspicious changes in the lungs. The current plan is to offer lung cancer screening to people between the ages of 50 and 75 who, to put it simply, have been heavy smokers for more than 25 years.
´Our data shows that, based on these criteria, we are overlooking some people who also have a high risk of lung cancer and would benefit from the early detection programme,’ says Prof. Jens Vogel-Claussen, head of the recently published HANSE study. ‘If we take more factors into account than just age and smoking history, we discover almost 20 percent more lung cancer cases,’ emphasises the radiologist. He has been Director of the Department of Radiology at Charité since October. He previously initiated the Hanse study at Hannover Medical School (MHH) and continues to supervise it there as study director.
The study, conducted by the German Centre for Lung Research (DZL), examined how well CT screening detects lung cancer at an early stage when participants are selected according to a comprehensive set of criteria, known as the PLCOm2012 score. In addition to a person's age and smoking history, it also takes into account their level of education, weight, the presence of chronic obstructive pulmonary disease (COPD), past cancers and whether there have been cases of lung cancer in the family.
More hits, fewer deaths
The results were compared with the selection criteria that are to form the basis for the planned lung cancer screening and which take only age and smoking history into account (‘NELSON score’). All individuals who were assessed as having a high risk of lung cancer based on one of the two scores underwent two low-dose CT scans at one-year intervals as part of the study. Suspected cases were reviewed in interdisciplinary case conferences and, if confirmed, treatment was initiated.
Among approximately 4,200 active or former smokers who were screened using the PLCOm2012 score, the researchers found lung cancer in 108 cases. This is 19.4 per cent more than in the NELSON comparison group of approximately 3,900 people, where 85 cases of cancer were detected. ‘If we use the more comprehensive PLCOm2012 score with a defined threshold value, we have to screen around 6 per cent more people, but we find significantly more cases of lung cancer,’ explains Prof. Martin Reck, chief physician of the oncology department at the LungenClinic Grosshansdorf and last author of the study. ‘This makes screening more efficient, meaning we have to perform fewer CT scans to diagnose a case of lung cancer.’
Women could benefit particularly
Women in particular benefit from the expanded list of criteria. On the one hand, they are more frequently affected: in the HANSE study, a total of 2.6 per cent of women were diagnosed with lung cancer, compared to 1.8 per cent of men. On the other hand, they are more likely to fall outside the narrow criteria list. ‘Many of the women in our study are active smokers, but have smoked fewer cigarettes over their lifetime than men and therefore do not meet the inclusion threshold currently applicable in Germany,’ explains Dr Sabine Bohnet, head of the Lung Cancer Centre at the UKSH's Lübeck campus and co-author of the study. ‘In addition, they are more likely to have a family history of lung cancer, a personal history of cancer or an additional COPD diagnosis. We assume that these risk factors are more significant in women than in men. Unfortunately, they are not included in the current list of criteria.’
The planned early detection screening aims to reduce mortality from lung cancer by detecting and treating the disease at an early stage. ‘Our study has shown that it is possible, but also necessary, to change the inclusion criteria for screening based on the results of the HANSE study,’ summarises Jens Vogel-Claussen. ‘Otherwise, we will overlook important risk groups.’
*Vogel-Claussen J et al. Effectiveness of NELSON versus PLCOm2012 lung cancer screening eligibility criteria in Germany (HANSE): a prospective cohort study. Lancet Oncol 2025 Nov 10. doi: 10.1016/S1470-2045(25)00490-5
**According to current plans, the following individuals are eligible for lung cancer screening: those with statutory health insurance between the ages of 50 and 75 who have smoked for at least 25 years and either still actively smoke or quit smoking less than ten years ago. Mathematically, tobacco consumption must amount to at least 15 pack-years (one pack-year is 20 cigarettes per day over one year).
About the HANSE study
The HANSE study is an investigator-initiated trial, meaning it was initiated by the researchers themselves. The NELSON inclusion criteria were compared with a PLCOm2012 score, which corresponds to a six-year risk of developing lung cancer of at least 1.58 per cent. Participants were recruited at Hannover Medical School (MHH), Schleswig-Holstein University Hospital on the Lübeck campus and the LungenClinic Grosshansdorf. All three locations are lung cancer centres certified by the German Cancer Society (DKG). The study was funded by the DZL and AstraZeneca as part of the Lung Ambition Alliance.
The HANSE study will continue: between autumn 2025 and summer 2026, participants already enrolled in the study who are at high risk of lung cancer will undergo further CT screening. In addition, for the first time, researchers will investigate whether biomarkers can be identified in the blood that could enable even earlier diagnosis of lung cancer in the future. The aim is to further improve the accuracy and effectiveness of screening.
Local contact: For further information on lung cancer screening at Hannover Medical School (MHH), please contact PD Dr Julian M. W. Glandorf, telephone 0511 532-3427, Glandorf.Julian@mh-hannover.de[IKJ1] and Dr Benjamin-Alexander Bollmann, telephone 0511 532-19302, Bollmann.Benjamin-Alexander@mh-hannover.de.