CHICAGO – Using a routine chest X-ray image, an artificial intelligence (AI) tool can identify non-smokers who are at high risk for lung cancer, according to a study being presented next week at the annual meeting of the Radiological Society of North America (RSNA).

Lung cancer is the most common cause of cancer death. The American Cancer Society estimates about 238,340 new cases of lung cancer in the United States this year and 127,070 lung cancer deaths. Approximately 10-20% of lung cancers occur in “never-smokers” – people who have never smoked cigarettes or smoked fewer than 100 cigarettes in their lifetime.

The United States Preventive Services Task Force (USPSTF) currently recommends lung cancer screening with low-dose CT for adults between the ages of 50 and 80 who have at least a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. The USPSTF does not recommend screening for individuals who have never smoked or who have smoked very little. However, incidence of lung cancer among never-smokers is on the rise, and—without early detection through screening—when discovered, these cancers tend to be more advanced than those found in smokers.


“Current Medicare and USPSTF guidelines recommend lung cancer screening CT only for individuals with a substantial smoking history,” said the study’s lead author, Anika S. Walia, B.A., a medical student at Boston University School of Medicine and researcher at the Cardiovascular Imaging Research Center (CIRC) at Massachusetts General Hospital (MGH) and Harvard Medical School in Boston. “However, lung cancer is increasingly common in never-smokers and often presents at an advanced stage.”

One reason federal guidelines exclude never-smokers from screening recommendations is because it is difficult to predict lung cancer risk in this population. Existing lung cancer risk scores require information that is not readily available for most individuals, such as family history of lung cancer, pulmonary function testing or serum biomarkers.

For the study, CIRC researchers set out to improve lung cancer risk prediction in never-smokers by testing whether a deep learning model could identify never-smokers at high risk for lung cancer, based on their chest X-rays from the electronic medical record. Deep learning is an advanced type of AI that can be trained to search X-ray images to find patterns associated with disease.

“A major advantage to our approach is that it only requires a single chest-X-ray image, which is one of the most common tests in medicine and widely available in the electronic medical record,” Walia said.

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