Illustration of surgical gloves holding a healthy lung, symbolizing reduced risks in lung cancer surgery.

Lung Cancer Screening: Are the Risks of Surgery Overstated?

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Theo Raines in Health & Wellness December 2025 • 5 min read.

"A new analysis suggests that the risks of surgery for screening-detected lung cancer may be lower than previously thought, potentially encouraging more people to get screened."


Lung cancer remains a leading cause of cancer-related deaths worldwide, but early detection through screening programs offers a chance to improve outcomes. The goal of lung cancer screening programs is clear: to identify at-risk individuals without symptoms and detect cancer at an early, treatable stage. However, the widespread adoption of lung cancer screening, particularly low-dose computed tomography (LDCT), has been hampered by concerns about potential risks, including the morbidity associated with surgical procedures performed to address abnormalities detected during screening.

A pivotal study, the National Lung Screening Trial (NLST), demonstrated a 20% reduction in lung cancer mortality with LDCT compared to chest X-ray screening. Despite this significant finding, the adoption of LDCT screening in the United States remained relatively low, with only 3.9% of eligible patients screened between 2010 and 2015. Several factors contributed to this low uptake, including the lack of demonstrated mortality benefit in some European studies, concerns about cost-effectiveness, and worries about the risks associated with LDCT screening, such as radiation exposure, false positives, and the potential for overtreatment. Among these concerns, the morbidity of surgical procedures performed as a result of screening-detected abnormalities stood out, with the NLST reporting a rate of 32%.

Now, a recent analysis is challenging these long-held perceptions. The study by Kemal et al., focusing on surgical patients within the NLST cohort, suggests that the risks of surgery in patients with screening-detected lung cancer may be overstated. By delving into the surgical outcomes of the NLST cohort, this research offers valuable insights that could reshape the discussion around lung cancer screening and encourage greater participation.

What the Data Says: Examining Surgical Risks in Lung Cancer Screening

Illustration of surgical gloves holding a healthy lung, symbolizing reduced risks in lung cancer surgery.

The NLST, while groundbreaking, did not have a predefined management protocol for addressing abnormalities detected during screening. This lack of standardization, coupled with the study's timeframe, resulted in a low utilization of preoperative PET scans and non-surgical biopsies. Consequently, a significant proportion of patients underwent lobectomy or pneumonectomy (83.98%), while a smaller percentage had sublobar resections (SLR) (16.1%). Video-assisted thoracoscopic surgery (VATS) was used in only 29.6% of cases.

Regarding complications after surgery, 15.5% of cases were classified as major, with prolonged air leak or bronchial stump leak being the most common (6.5% of the cohort, accounting for 42% of the major complications). The NLST data did not differentiate between these two conditions, but it is likely that bronchial stump leak was uncommon. Respiratory failure occurred in 3.7% of patients, MACE (major adverse cardiac events) in 0.8%, and CVA (cerebrovascular accident) in 1%. Reassuringly, the overall 30-day mortality rate was low, at 1.7%.

  • Lobectomy or Pneumonectomy: Performed in 83.98% of patients.
  • Sublobar Resection (SLR): Performed in 16.1% of patients.
  • VATS Utilization: Used in 29.6% of surgical procedures.
  • Major Complications: Observed in 15.5% of cases.
  • Prolonged Air Leak or Bronchial Stump Leak: Most common major complication (6.5% of cohort).
  • Respiratory Failure: Occurred in 3.7% of patients.
  • MACE: Occurred in 0.8% of patients.
  • CVA: Occurred in 1% of patients.
  • 30-Day Mortality Rate: 1.7%.
Multivariate analysis revealed that the use of SLR was significantly associated with decreased complications, while the use of VATS approached significance. These findings suggest that less invasive surgical approaches may lead to better outcomes for patients undergoing surgery for screening-detected lung cancer.

The Future of Lung Cancer Screening: A Call for Optimized Strategies

The findings of the Kemal study, along with the reconfirmed benefits of CT screening demonstrated by the NELSON trial, call for a reassessment of the perceived risks associated with surgery in lung cancer screening. Post-hoc analysis of NLST data suggests decreased complications with the use of SLR and VATS. To further improve outcomes, standardized CT volumetry with artificial intelligence technology, protocolized management algorithms for lung nodules, and state-of-the-art surgical techniques should be incorporated into future designs of LDCT lung screening programs. By embracing these advancements, we can reduce the risks associated with surgery and encourage more individuals to participate in lung cancer screening, ultimately leading to earlier detection and improved survival rates.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

1

What is the primary goal of lung cancer screening programs, and how does it relate to the detection of cancer?

The primary goal of lung cancer screening programs is to identify at-risk individuals without symptoms and detect cancer at an early, treatable stage. Early detection through screening programs offers a chance to improve outcomes, and the use of Low-dose computed tomography (LDCT) has shown to be effective in achieving this goal by detecting abnormalities that might indicate cancer at its onset.

2

What were the main concerns that hindered the widespread adoption of LDCT screening, and what role did surgical risks play in these concerns?

Several factors contributed to the low adoption of LDCT screening, including lack of demonstrated mortality benefit in some European studies, concerns about cost-effectiveness, and worries about the risks associated with LDCT screening, such as radiation exposure, false positives, and the potential for overtreatment. Among these concerns, the morbidity of surgical procedures performed as a result of screening-detected abnormalities stood out, with the National Lung Screening Trial (NLST) reporting a rate of 32%.

3

In the context of the National Lung Screening Trial (NLST), what surgical procedures were most commonly performed, and what were the rates of major complications and mortality?

Within the NLST, the most common surgical procedures were Lobectomy or Pneumonectomy, performed in 83.98% of patients. Sublobar Resection (SLR) was performed in 16.1% of patients, and Video-assisted thoracoscopic surgery (VATS) was used in only 29.6% of cases. Major complications were observed in 15.5% of cases. The most common major complication was prolonged air leak or bronchial stump leak (6.5% of the cohort). The overall 30-day mortality rate was 1.7%.

4

How did the Kemal et al. study challenge the existing perceptions of surgical risks in lung cancer screening, and what surgical approaches were associated with improved outcomes?

The Kemal et al. study suggests that the risks of surgery in patients with screening-detected lung cancer may be overstated. The study's findings, along with the reconfirmed benefits of CT screening demonstrated by the NELSON trial, call for a reassessment of the perceived risks associated with surgery in lung cancer screening. Multivariate analysis revealed that the use of SLR was significantly associated with decreased complications, while the use of VATS approached significance. These findings suggest that less invasive surgical approaches may lead to better outcomes for patients undergoing surgery for screening-detected lung cancer.

5

What advancements and strategies are recommended to optimize lung cancer screening programs and further reduce surgical risks?

To further improve outcomes, the article suggests that standardized CT volumetry with artificial intelligence technology, protocolized management algorithms for lung nodules, and state-of-the-art surgical techniques should be incorporated into future designs of LDCT lung screening programs. By embracing these advancements, we can reduce the risks associated with surgery and encourage more individuals to participate in lung cancer screening, ultimately leading to earlier detection and improved survival rates. The findings of the Kemal study, along with the reconfirmed benefits of CT screening demonstrated by the NELSON trial, call for a reassessment of the perceived risks associated with surgery in lung cancer screening.

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