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Freedom251 › Blog › cancer screening

Can a Urine Test Catch Lung Cancer Early? What the Evidence Shows

By Freedom251 Team · · 3 min read

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Urine tests for lung cancer are being studied, but none is established for routine screening. A 2024 study found promising results for two urine metabolites, creatine riboside (CR) and N-acetylneuraminic acid (NANA), particularly among nonsmokers. The findings do not show that the test prevents deaths or can replace a scan. In the United States, the cited screening guidance recommends annual low-dose CT (LDCT) for adults who meet its high-risk criteria—not urine biomarkers.

Can a urine test detect lung cancer early?

Possibly in the future, but current evidence supports urine biomarkers as a research approach, not a screening test people can routinely request. Researchers are investigating whether these markers could help identify people who might benefit from established screening, including some nonsmokers who do not meet the smoking-history criteria in US guidance.

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A 2024 study in Clinical Cancer Research examined CR and NANA in urine. Using liquid chromatography–mass spectrometry, researchers compared people with lung cancer with age- and sex-matched controls. The exploratory cohort included 846 participants, and an independent validation cohort included 505. In nonsmokers, the combined markers had an area under the receiver operating characteristic curve (AUC) of 0.94 in the exploratory cohort and 0.80 in the validation cohort. The study report describes these as cohort findings and says prospective studies are warranted.

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AUC measures how well a test separates cases from controls in the studied data. It is not the chance that a person with a positive result has cancer, and it does not establish that using the test for screening improves health outcomes. The difference between the exploratory and validation results also underscores why findings need further study before clinical use.

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How this differs from other urine research

CR and NANA are metabolites. Other teams have investigated distinct urine-based approaches, which should not be treated as the same test or as interchangeable evidence.

Approach What was studied What the reported evidence shows
CR and NANA metabolites 2024 exploratory and independent validation cohorts Combined-marker AUCs of 0.94 and 0.80 among nonsmokers, respectively; these are study discrimination results, not proof of screening benefit. American Association for Cancer Research, 2024
Urinary extracellular-vesicle microRNA Case-control assay study, with training and test sets For early-stage detection, sensitivity and specificity were 82.0% and 92.5% in the training set, and 88.2% and 87.0% in the test set. These results do not establish population-screening performance. npj Precision Oncology, 2026
Urine biosensor platform Report based on a 238-patient cohort Reported sensitivity of 91%, specificity of 86%, and AUC of 0.86 in that study cohort—not established performance for population screening. American Association for Thoracic Surgery, 2026

Earlier studies also explored urinary metabolites. A 2014 study reported CR and NANA as candidate diagnostic and prognostic markers; a 2016 prospective cohort study found associations between CR and lung cancer risk before diagnosis, with results varying by population subgroup. These findings add research evidence but do not establish a recommended clinical screening assay. 2014 study; 2016 study.

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Is a urine test available now, and can it replace CT?

The cited studies do not establish a commercially available urine screening test, regulatory clearance, or a clinical pathway for using these assays. A urine biomarker result is not a diagnosis. The evidence described here also does not show that urine screening reduces mortality or can replace imaging.

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For US screening, the US Preventive Services Task Force (USPSTF) recommendation located for this article is dated March 9, 2021. It recommends annual LDCT for eligible high-risk adults and says measurement of biomarker levels has not been found beneficial as a screening modality. Check the USPSTF recommendation for any update; the criteria below reflect that cited guidance.

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Who should get lung cancer screening in the United States?

Under the cited USPSTF recommendation, annual LDCT screening is recommended for adults aged 50–80 who have a smoking history of at least 20 pack-years and currently smoke or quit within the past 15 years. One pack-year means smoking an average of one pack per day for one year; for example, two packs per day for 10 years is 20 pack-years.

  • Screening should stop once a person has not smoked for 15 years.
  • It should also stop if a health problem substantially limits life expectancy or the ability or willingness to undergo curative lung surgery.

These are US recommendations, not universal eligibility rules. If you may qualify, ask a clinician about LDCT rather than waiting for or seeking an unvalidated urine test.

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