Dr. Qinghua Zhou: Promoting the Popularization of Lung Cancer Screening and Building a Single-Disease MDT Diagnosis and Treatment System | WCLC 2026

Editor's Note: The 2026 World Conference on Lung Cancer (WCLC 2026), hosted by the International Association for the Study of Lung Cancer (IASLC), was held in Seoul, South Korea, from September 12 to 15, 2026. FOCUS Clinical Scientists specially invited Dr. Qinghua Zhou from West China Hospital of Sichuan University to share his insights on the difficulties in popularizing low-dose CT lung cancer screening in China and the diagnosis and treatment strategies for locally advanced lung cancer.

 

FOCUS Clinical Scientists: Low-dose CT lung cancer screening is advancing rapidly in China. To translate screening evidence into a nationwide routine screening program, what core obstacles still remain?

Dr. Qinghua Zhou: Lung cancer screening in China began in 1991, and I was one of the participants. At that time, we carried out related work in Gejiu and Xuanwei, Yunnan, jointly with the National Cancer Institute (NCI) of the United States and the Cancer Hospital of the Chinese Academy of Medical Sciences. Later, we collaborated with the Chinese Academy of Medical Sciences and obtained a national "Tenth Five-Year" science and technology project. After that, as the head of the expert group for early diagnosis and early treatment of rural lung cancer under the Ministry of Health, I initially worked in two locations: Dagang in Tianjin and the Yunnan Tin Mine in Gejiu, Yunnan. In the early days, we used X-ray and sputum cytology, and established a cohort-controlled study in Gejiu, Yunnan, which continues to this day. Unfortunately, after the Yunnan Tin Mine underwent restructuring, much of the work was forced to stop. In the early 1990s, I had to travel to Gejiu every month. The journey was long, leaving early and returning late. At that time, my main task was to help them establish clinical work, organize cohort studies, and identify and verify screened patients; those requiring surgery were operated on by me.

Later, the results of the U.S. National Lung Screening Trial and European lung cancer research projects were published, showing that low-dose spiral CT, compared with traditional X-ray examination, can reduce lung cancer mortality by 20%–26%, or even 30%. Around 2000, only 5%–7% of lung cancers diagnosed in hospitals were early-stage lung cancer, while the rest were mostly intermediate-stage, locally advanced, or predominantly advanced. With the application of low-dose CT, the early diagnosis rate has improved significantly. However, several problems remain: first, overdiagnosis, with a large number of nodules detected that are difficult to determine as lung cancer; second, in terms of treatment, whether surgery should be performed is also controversial, with cases of non-lung cancer being diagnosed as lung cancer and overtreated, and cases undergoing surgery when it was not appropriate; third, in primary care and rural areas, low-dose CT screening is difficult to popularize, due to geographical, economic, and various other constraints. Large cities have done relatively well; for example, there are urban cancer screening programs, and we mainly participate in urban screening programs funded by central fiscal transfer payments. Provinces, municipalities, and districts also have regional programs, as well as opportunistic screening during physical examinations, which have also detected many early-stage tumors. To achieve popularization, it is a systematic project that requires comprehensive national medical insurance coverage, which is quite difficult. In addition, training for primary care personnel needs to be strengthened, especially in the western regions, which still face problems such as training of technical personnel, technical conditions, and popularization of equipment. Only by comprehensively improving these aspects can we fully raise the screening rate and popularization rate of lung cancer in China.

 

FOCUS Clinical Scientists: At WCLC 2026, multiple studies on neoadjuvant immunotherapy for locally advanced non-small cell lung cancer were presented. In your view, for patients with stage IIIA–IIIB disease, how should we balance neoadjuvant systemic therapy and radical surgery?

Dr. Qinghua Zhou: Clinically, there are now multiple treatment modalities for advanced lung cancer, including targeted therapy, immunotherapy combined with chemotherapy, antibody-drug conjugates (ADCs), and bispecific antibodies. For stage I lung cancer, the vast majority of patients can achieve long-term survival through surgery, with a rate exceeding 90%. The problems are mainly concentrated in locally advanced disease, because surgery is less involved in the treatment of stage III lung cancer, and such patients are mostly referred to internal medicine for treatment. In fact, many patients with stage III lung cancer can achieve good prognosis and long-term survival through surgery. As mentioned earlier, the 5-year survival rate after neoadjuvant chemoimmunotherapy can reach over 92%, and the 3-year survival rate after targeted neoadjuvant therapy and induction EGFR-TKI therapy is also close to 100%. It is believed that the 5-year survival rate will likewise be close to 100%, because recurrence and metastasis are already very rare after three years. Therefore, domestic colleagues should form multidisciplinary diagnosis and treatment (MDT) teams regardless of department or boundaries. This team should not be limited to temporary consultations, but should be jointly built at both the organizational and academic structural levels. For example, a cross-disciplinary single-disease center should be established around the single disease of lung cancer, covering lung cancer screening, early diagnosis, treatment, prognosis and rehabilitation, recurrence and metastasis, as well as molecular biology, bioinformatics, pathology, imaging, nuclear medicine, and traditional Chinese medicine. Through such an organizational and academic structure, providing each patient with individualized multidisciplinary comprehensive treatment based on molecular analysis and molecular typing can better solve these problems. Among advanced patients, especially those with isolated metastasis or single-organ metastasis, those who obtain surgical opportunities through induction therapy and then receive postoperative adjuvant therapy have better long-term survival prognosis than those receiving drug therapy alone. Continuous efforts are still needed in this regard.

 

Expert Profile

Dr. Qinghua Zhou

West China Hospital of Sichuan University

He specializes in multidisciplinary comprehensive treatment centered on lung cancer surgery, the molecular mechanisms and signal regulation of lung cancer invasion and metastasis, and "molecular typing" and "individualized lung cancer" treatment based on molecular markers. He was the first internationally to propose and establish "reconstructive surgery for thoracic tumors," and in long-term clinical work has established more than 40 new theories, concepts, and techniques for surgical treatment of locally advanced non-small cell lung cancer, locally advanced tracheal tumors, and locally advanced mediastinal tumors; he has pioneered more than 40 surgical procedures for locally advanced non-small cell lung cancer, locally advanced tracheal tumors, and locally advanced mediastinal tumors.