On July 1, 2022, the Ministry of Health and Welfare launched the Lung Cancer Early Detection Program to provide biannual low-dose computed tomography (LDCT) lung screening for high-risk groups. Taiwan is the first country to provide lung screening for heavy smokers and individuals with a family history of lung cancer. Those in the following groups at high risk for lung cancer may apply for screening at any given hospital under the program: (1) Individuals with a family history of lung cancer, specifically, men aged between 50 and 74 years and women aged between 45 and 74 years whose parents, children, or siblings have been diagnosed as having lung cancer, and (2) individuals with a history of heavy smoking, specifically, individuals aged between 50 and 74 years with a smoking history of 30 or more pack-years who are willing to quit smoking or who have quit smoking within the past 15 years. However, lung cancer screening cannot prevent lung cancer. Smoking remains the main risk factor for lung cancer, and smokers are recommended to use smoking cessation services and reclaim their health.

The stage of lung cancer determines patients’ five-year survival rate 
The World Health Organization ranks lung cancer as the leading cause of cancer death. Taiwan’s standardized mortality rate for lung cancer has been in decline for 9 consecutive years. However, lung cancer remains the main cause of cancer death in Taiwan, accounting for 9,629 deaths in 2020 and contributing to approximately one fifth (19.2%) of total cancer deaths (19.2%).
Lung cancer has a high mortality rate and low survival rate, both of which are mainly determined by the stage at diagnosis. In 2019, of the patients diagnosed as having lung cancer, 4.2%, 29.1%, 4.3%, 12.3%, and 50.1% were diagnosed as stage zero, one, two, three, and four, respectively. The 5-year survival rate of patients with stage one, two, three, or four lung cancer is approximately 90%, 60%, 30%, and 10%, respectively, indicating considerable differences between each stage.

The first country to provide lung cancer screening based on family history and heavy smoking habits
Currently, LDCT is the only internationally recognized screening tool for the early detection of lung cancer and can reduce the mortality rate of lung cancer among heavy smokers by approximately 20%. Among overseas health care programs, Medicare and Medicaid in the United States offer both smoking cessation services and annual LDCT lung screening for heavy smokers. The National Lung Cancer Screening Program in South Korea offers smoking cessation services and biannual LDCT lung screening for heavy smokers. 
Only 5.9% of female patients with lung cancer in Taiwan have a history of smoking. Since 2014, the Ministry of Health and Welfare subsidized the Taiwan Lung Cancer Society’s Taiwan Lung Cancer Screening for Never-Smoker Trial (TALENT) project to identify nonsmoking related risk factors for lung cancer. The project was spearheaded by Academia Sinica academician Yang Pan-chyr, who lead 17 hospitals in participating in the research project. The first round of LDCT lung cancer screening results revealed that relative to other groups at high risk for lung cancer, those aged between 50 and 74 years with a family history of lung cancer (e.g., patients’ parents, children, or siblings diagnosed as having lung cancer) have a high detection rate of lung cancer.
Yang indicated that most international research on lung cancer screening has focused on smokers, and only a small number of countries have offered national lung cancer screening services for heavy smokers. However, the TALENT program indicated that having a family history of lung cancer is the main risk factor for lung cancer in nonsmokers. Accordingly, in addition to heavy smokers, the Health Promotion Administration provides LDCT lung cancer screening for those with a family history of lung cancer. Taiwan is the first country to implement such screening measures, thereby demonstrating the government’s thorough efforts to protect citizen health.

In addition to providing regular lung cancer screening to heavy smokers or those with a family history of lung cancer, smokers should be encouraged to quit smoking 
Former Health Minister Chen Shih-chung indicated that heavy smokers, particularly those who are men, are the main high-risk group for lung cancer. Most women who develop lung cancer do not smoke. To strengthen lung cancer screening policies for female nonsmokers, numerous expert meetings were held to lower the recommended age for lung cancer screening for women with a family history of lung cancer to 45 years. This provides women at risk of developing lung cancer with greater access to lung cancer screening services.
LDCT screening can assist in the early diagnosis of lung cancer and reduce the lung cancer mortality rate. Citizens must understand that although nodules are often identified through LDCT, most nodules are benign. Those with abnormal screening results must participate in follow-ups at intervals recommended by their physician to check for new nodules or changes in existing nodules. Those diagnosed as having lung cancer should follow the treatment plan recommended by their physician to ensure early discovery of malignant tumors and early treatment. 
Director-General of the Health Promotion Administration Wu Chao-chun stated that lung cancer screening is the fifth type of cancer screening provided by the government after cervical cancer, breast cancer, oral cavity cancer, and colorectal cancer screening. Lung cancer screening policies were established on the basis of international evidence, domestic research results, and discussions between experts and relevant academic associations. Citizens who meet the criteria for lung cancer screening can inquire about screening at hospitals under the Lung Cancer Early Detection Program to ensure early diagnosis and early treatment. 
 
Note: Pack–year: Number of cigarette packs smoked per day×years of smoking history (e.g., one pack per day for 30 years = 30 pack-years)