At least one lung nodule was found in 4,377 (42.0%) of the participants (47.5% of men; 37.7% of women). The prevalence of lung nodules increased with age. Clinically relevant lung nodules (nodules measuring 6 to 8 mm) were present in 11.1% of participants, with the prevalence again increasing with age. Men were more likely than women to have lung nodules, and men were more likely than women to have multiple nodules.

"Our study revealed the presence of clinically relevant nodules in 11.1 percent of a non-smoking cohort, traditionally considered low risk," Dr. Vliegenthart said. "This was higher than we expected and even similar to the prevalence reported in high-risk populations of smokers."


In recent years, the proportion of smoking individuals in Western populations has been declining due to the success of smoking cessation programs, Dr. Vliegenthart noted.

"This shift makes our study, which provides foundational and comprehensive data on lung nodules in non-smokers, even more critical," she said.

The results imply that, given the increasing numbers of chest CT scans for various clinical indications, these incidental nodules will increase the number of follow-up scans and workups when using current nodule follow-up guidelines. As the patients are followed in the LifeLines cohort over time, we can gather more data to determine if lower risk patient population may need altered follow-up management.

"We know that the incidence of lung cancer in this population (LifeLines cohort), is very low (0.3%), suggesting that most of the clinically relevant and even actionable nodules in a non-smoking cohort are benign," Dr. Vliegenthart said. "Future data on lung cancer diagnosis in ImaLife participants with clinically relevant and actionable nodules may help to optimize nodule management recommendations for individuals considered at low risk."

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