Selective Testing Finds More Inherited Lung Cancer Risk
Patients chosen by clinical criteria carried far more pathogenic germline variants than unselected lung cancer patients.
Updated on Nov. 3, 2026 in Cancer
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Should doctors test all lung cancer patients for inherited gene mutations, or only some?
A systematic review of 49 studies found that germline genetic testing in lung cancer uncovers more pathogenic variants when patients are selected for testing than when they are not. The review was published in the journal Lung Cancer and reflects how the field is weighing who should be tested.
Why it matters
Lung cancer has a lower baseline rate of inherited pathogenic variants than some other cancers, which has fueled debate over whether broad testing of all patients is worthwhile. The findings suggest that clinical selection can meaningfully raise the yield of testing, which bears on how inherited risk is identified and who may benefit from follow-up.
This is a systematic review of 49 studies that compared germline testing yield across unselected and selected lung cancer populations. Pathogenic variant prevalence was roughly 6% in unselected cohorts versus about 27% in clinically selected cohorts, though the synthesis was descriptive rather than formally compared statistically.
The players
Lung Cancer
A peer-reviewed oncology journal that publishes research on the diagnosis, treatment, and biology of lung cancer.
ASCO Post
The news publication of the American Society of Clinical Oncology, which reports on cancer research and clinical practice.
The details
Researchers grouped the studies by how patients were chosen for testing, then compared the proportion of patients found to carry a pathogenic germline variant. Ten studies tested across multiple cancer types, twenty-one tested unselected lung cancer populations, and eighteen applied some form of selection before testing. Family history, a common clinical clue to inherited risk, was rarely used as a formal selection criterion.
Timeline
The systematic review was published in the journal Lung Cancer in 2026, in volume 219.
The review's findings are reported in an article first published by ASCO Post on September 25, 2022, which discussed germline testing for lung cancer.
Health Landscape
Germline testing has moved from being reserved for a few cancers toward wider use in oncology, but lung cancer has lagged because its inherited variant rate is lower than in several other tumor types. This review adds evidence that testing lung cancer patients chosen by clinical criteria yields substantially more findings than testing unselected patients.
If you have lung cancer or a strong family history of cancer, the findings suggest that clinical criteria may help identify who is worth testing for inherited variants. Bring family cancer history to your oncologist, since it can inform whether genetic testing is appropriate for you.
The takeaway
Patient selection appears to matter a great deal in lung cancer germline testing, and family history is a clue that is still underused. Ask your care team whether inherited-risk testing is relevant to your situation and what your family history might mean.
Further reading
For more on how inherited risk shapes cancer care, explore the Cancer section.
Live Poll
Should doctors test all lung cancer patients for inherited gene mutations, or only some?
