Taiwan's most prolific lung cancer surgeon is urging every adult over 40 to undergo low-dose CT screening — regardless of whether they smoke — after data showed the island's government-subsidized screening program has reached barely a quarter of its original target in three years of operation.
Chen Jin-shing(陳晉興), director of surgery at National Taiwan University Hospital (NTUH) and one of Asia's leading thoracic surgeons, made the call in an interview with Storm Media. His remarks come as lung cancer has entrenched itself at the top of three national health statistics simultaneously: the leading cause of cancer deaths for 22 consecutive years, the most common new cancer diagnosis for the third straight year, and the single largest driver of cancer treatment spending. Taiwan now records nearly 20,000 new lung cancer cases annually — a figure Chen compared, grimly, to a blue-chip stock that will not stop climbing.
A Screening Drive That Found Only 3,000 Patients in Three Years
Taiwan introduced a program offering free low-dose computed tomography — LDCT — every two years for high-risk groups, primarily heavy smokers and people with a family history of lung cancer. The program's original ambition was to screen 800,000 to 1,000,000 people over three years. It has so far reached roughly 250,000, detecting approximately 3,000 patients.
Chen is direct about the cause. Under current regulations, only hospitals with more than 20 beds are permitted to install LDCT equipment. For most Taiwanese outside major urban centers, that means traveling far to a large hospital — and then waiting. At NTUH, Chen noted, booking an LDCT appointment requires between six months and a full year.
"The government's policy direction is good — but not good enough," Chen said. "Because accessibility is so low, the number of people who can actually benefit is very limited."
There is also a widespread misconception working against early detection: many people assume the chest X-ray included in annual health checkups can screen for lung cancer. It cannot. Only LDCT provides sufficient resolution to catch tumors at an early, treatable stage.
Mobile CT Vans and Relaxed Rules: Chen's Blueprint for Closing the Gap
Chen is pushing two concrete policy changes. First, he wants the 20-bed installation threshold eliminated so that small rural hospitals and primary care clinics can operate LDCT equipment. Second — and more visibly — he is championing county-government-operated mobile CT screening vehicles that would rotate through shopping malls, community centers, and weekend markets, bringing the scan directly to residents who cannot easily travel to metropolitan hospitals.
The mobile van proposal is already gaining traction. Taoyuan City has purchased one such vehicle at a cost of approximately NT$30 million (roughly US$930,000). Changhua County and Taipei City have both entered negotiation and evaluation stages.
Chen sees the mobile model as the fastest route to closing the gap between the program's ambition and its actual reach — particularly for older, rural populations who face the steepest barriers to accessing care at NTUH or other academic medical centers.
Why Non-Smokers Cannot Afford to Skip the Scan
The assumption that lung cancer primarily threatens heavy smokers has become dangerously outdated in Taiwan. Research from the Health Promotion Administration, Taiwan's national public health agency, has found that people with a family history of the disease face twice the risk of developing lung cancer compared to smokers — a finding Chen says most of his patients are unaware of. More troubling, a significant share of patients who develop the illness have neither a smoking habit nor any family history.
Chen includes himself in that group. Despite never having smoked and having no family history of lung cancer, a routine scan found three nodules in his own lungs, which he now monitors regularly. He is careful to note that more than 90% of lung nodules turn out to be benign — traces of old infections or scar tissue from past inflammation — but their presence must be tracked.
"Lung cancer in its early stages is almost entirely symptom-free," he said. "By the time someone is coughing blood, losing their voice, struggling to breathe, or feeling bone pain, the disease has usually already reached late stage."
The cancer's shifting profile makes that silence particularly dangerous. As Taiwan's anti-smoking campaigns have taken hold, small-cell lung cancer — historically linked to male smokers — has declined. Lung adenocarcinoma in non-smoking women has surged in its place, now accounting for roughly 70% of all lung cancer cases in Taiwan. Environmental exposures compound the risk further: fine-particulate air pollution (PM2.5), asbestos found in older building materials — which was only fully banned in Taiwan in 2018 — and possible traces of asbestos in low-cost cosmetics and baby products sold in traditional markets. The rise of e-cigarettes and heated tobacco products has added newer unknowns.
Chen frames the underlying biology plainly. Cancer, he argues, is a process in which the body's capacity to repair accumulated genetic mutations gradually degrades as a person ages. On that basis, he recommends that anyone who has turned 40 — even without qualifying for public subsidies — pay out of pocket for a single LDCT scan. The out-of-pocket cost in Taiwan runs between NT$5,000 and NT$6,000, or roughly US$155 to US$185.
After 20,000 Surgeries, a Blunt Warning About Late-Stage Costs
Chen has performed more than 20,000 operations in his career, over 10,000 of them for lung cancer. The gap he has witnessed between what early-stage and late-stage patients experience has defined his advocacy for wider screening.
A Stage IV patient who survives surgery faces years of anxiety about recurrence and a dramatically reduced ability to work. The treatment costs that follow are severe. Targeted therapy drugs typically run NT$1 million to NT$2 million per year; newer precision medicines not yet covered by Taiwan's National Health Insurance can exceed NT$200,000 per month. "This is burning through money," Chen said. "People without financial resources who develop late-stage lung cancer face a truly desperate situation."
The contrast with Stage I is stark. A patient whose tumor is found and removed early typically recovers fully, with minimal disruption to their life. The words Chen says most often to those patients after surgery: "Congratulations — there's nothing to worry about now. Come back next year for a follow-up."
He frequently cites former Vice President Chen Chien-jen as a case study in what early detection makes possible. In 2015, while serving as vice president of Academia Sinica — Taiwan's premier research institution — Chen Chien-jen was found to have early-stage lung adenocarcinoma. Surgery performed by Chen Jin-shing led to a full recovery. In the years that followed, Chen Chien-jen went on to serve as Taiwan's vice president, premier, and president of Academia Sinica. "With early detection and a cure," Chen said, "you have a whole lifetime left to do meaningful things."
Asia's First Tracheal Transplant Opens a New Frontier
Chen's contributions to thoracic medicine extend beyond lung cancer. He is the first surgeon in Asia to have successfully performed a tracheal transplant — a procedure developed to treat patients with tracheas so severely damaged that conventional repair is impossible.
The technique uses a donor's aorta, which is grafted onto the patient's diseased trachea. The transplanted blood vessel subsequently grows its own cartilage, effectively transforming into functional tracheal tissue. Securing approval from Taiwan's Ministry of Health and Welfare ethics review board required Chen to navigate an institutional rule stipulating that the first patient must survive at least three months before the procedure could be repeated. Given a surgical mortality rate approaching 50%, Chen visited a local temple with his wife to pray the night before the first operation.
The surgery succeeded. That patient has now survived more than five years. Chen's team has since completed eight tracheal transplants in total, with six patients surviving — a success rate above 70%. For patients with no other options, the procedure has opened a path that did not previously exist.
Despite seeing Taiwan's annual new lung cancer diagnoses approach 20,000, Chen is not pessimistic. He reads the rising count as evidence that more early-stage patients are being identified and treated in time. The goal he is working toward is to break the cycle in which the disease has claimed more than 10,000 lives per year in Taiwan for five consecutive years — not by accepting those deaths as inevitable, but by ensuring that the scan capable of preventing them is within reach of everyone who needs it. （Related： Exclusive | Taiwan Is the World's Hottest Stock Market. That's the Problem. ｜ Latest ）
