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Key messages Enthusiasm is growing for lung cancer screening in people who have never smoked, despite their low risk of lung cancer death CT screening of never smokers has become common in parts of East Asia and has made the harms obvious Screening has resulted in more overdiagnosis and more lung resection (often without histological confirmation of cancer) The East Asian experience also highlights the deceptive feedback from screening, including high early stage detection rates and high survival rates Decisions about screening should be based on evidence from randomised trials in people who have never smoked not extrapolated from evidence in people who smoke heavily Footnotes Contributors and sources: HGW is a primary care practitioner and cancer epidemiologist who has investigated the effects of screening for 30 years