Lung Cancer Screening and Prevention

Lung cancer is the most common cancer diagnosis worldwide despite steep declines in smoking; ex-smokers and people with long exposure to high air pollution remain at elevated risk. Prevention has meant lifestyle advice. Two linked findings from Charlie Swanton's group (Francis Crick Institute / UCL) now point at drug-based prevention targeted by a blood test.

The inflammatory pathway (2023)

Air pollution triggers release of interleukin-1 beta (IL-1β). When IL-1β reaches lung cells carrying dormant cancer-causing mutations, it activates them; the cells proliferate into tumours. Blocking IL-1β in pollution-exposed mice stopped tumours forming.

The 14-protein signature (Cell, 4 June 2026)

• Discovery: machine learning on plasma proteomics from ~48,000–50,000 UK Biobank participants found 14 proteins whose levels rise five or more years before a lung-cancer diagnosis. The signature reflects an inflamed lung environment, not the tumour itself.
• Validation: replicated in eight further datasets worldwide, including a Taiwanese cohort with few smokers, and in a mouse model.
• Prevention test: retrospective reanalysis of Novartis's 2017 CANTOS trial of canakinumab (an IL-1β blocker; ~4,650 participants reanalysed) — the drug failed for heart attacks but trial safety data recorded cancer incidence. In people with a high signature, canakinumab nearly halved lung-cancer risk: 55 treated to prevent one case, comparable to statins for heart attacks. In low-signature people, >1,500 would need treatment per case prevented.

Next steps named in the source

• A commercial blood test for the signature.
• Screening other anti-inflammatory drugs for the same effect.
• Fresh UK Biobank data (within two years) may yield analogous signatures for other cancers — the precedent is aspirin preventing colorectal cancer in Lynch-syndrome carriers.

What is unproven

• The canakinumab result is a retrospective subgroup reanalysis of a cardiovascular trial, not a prospective prevention trial.
• No prospective trial of signature-guided preventive therapy has been run; cost, side-effects of long-term IL-1β blockade and uptake are untested.

Related

• Predicting and Preventing Lung Cancer (Economist) — source article (2026-06-13).
• KRAS Inhibitors — KRAS-mutant lung cancer is a treatment-side target; this page is the prevention side.
• Cancer Vaccines — lung cancer is a next target for the personalised mRNA vaccine (recurrence prevention after surgery).