This transcript has been edited for clarity.
Hello. I’m Dr Ticiana Leal. I’m a thoracic medical oncologist and director of the thoracic oncology program at the Winship Cancer Institute of Emory University in Atlanta, Georgia. Today I will be providing lung cancer screening updates.
As background, most patients present with advanced-stage lung cancer at initial diagnosis. However, in the decades since the United States Preventative Services Task Force first recommended lung cancer screening in 2013, we have seen a shift, and the proportion of early-stage diagnoses has increased, and fewer patients are now diagnosed at late stages. The goal of any screening, including lung cancer screening, is to detect the disease early when it is not causing symptoms and when the treatment will be most successful.
The current recommendation is for low-dose CT, which is based on the results of two very important trials called the National Lung Screening Trial (NLST) as well as the NELSON trials. These trials showed that lung cancer screening improved overall survival and likely drove the shift in diagnosis from advanced to early-stage disease.
The screening recommendations have been broadened in order to increase rates of early detection and to increase uptake of lung cancer screening for populations at high risk for lung cancer. Some of the recommendations include broadening or removing the upper age limit. Previously, screening was recommended for ages 55-74, but now the American Cancer Society recommends annual low-dose CT screening for individuals aged 50-80 years old.
Eligibility criteria in patients with a smoking history have also broadened. Patients now qualify if they currently smoke, or have ever smoked, regardless of when they quit, with at least a 20-pack-year history (down from 30). Importantly, current smokers should also have access to smoking cessation support.
One thing that we also need to work on is broadening screening for high-risk populations and to also include underrepresented patients.
A study presented at ASCO 2025 demonstrated that in high-risk populations, such as those in the Mississippi Delta, the rates of lung cancer diagnosis and incidental pulmonary nodules were much higher than in the NLST trial — more than fourfold greater than the 1.1% observed — demonstrating the impact of lung cancer screening in the higher risk population.
Certainly there are patients that are still ineligible for lung cancer screening. However, smoking exposure still remains a critical factor to assessing risk and determining a favorable risk-benefit ratio for screening.
For patients with no smoking history, at this time, they are ineligible for lung cancer screening. This goes for individuals younger than age 50 and those who have less than a 20-pack-year smoking history. Also, patients who have risk for secondhand smoke are not eligible for lung cancer screening.
If an individual thinks they are high risk for lung cancer yet do not currently fit the screening criteria, it is important to discuss this with their healthcare provider. They may be eligible for clinical trials evaluating broader screening as we continue to learn more about people at risk for lung cancer.
It is important to note that patients with symptoms suspicious for lung cancer — such as cough or shortness of breath — are not eligible for screening. They should instead undergo a diagnostic CT scan. For those with an abnormal CT scan during screening, radiologists use specific criteria called the Lung-RADS to classify the risk of lung cancer for that individual.
Depending on risk stratification from the radiology findings, patients may be advised to schedule a follow-up sooner than 1 year or, in some cases, to have a biopsy. Many patients with identified lung nodules may be monitored more closely, and some institutions now offer lung nodule clinics to ensure appropriate follow up. Importantly, finding a lung nodule on a lung cancer screening test does not mean the patient will ever develop lung cancer, but it may mean that they need closer monitoring.
Future investigations are required to reduce the risk of high false-positive rates. In clinical trial settings, blood tests are being incorporated to help identify patients at higher risk of lung cancer during screening. I would also like to emphasize the importance of increasing lung cancer screening rates — not only in the US but worldwide.
I believe these are all positive changes and very important for us to address. Thank you very much for listening.
This transcript has been edited for clarity.
Hello. I’m Dr Ticiana Leal. I’m a thoracic medical oncologist and director of the thoracic oncology program at the Winship Cancer Institute of Emory University in Atlanta, Georgia. Today I will be providing lung cancer screening updates.
As background, most patients present with advanced-stage lung cancer at initial diagnosis. However, in the decades since the United States Preventative Services Task Force first recommended lung cancer screening in 2013, we have seen a shift, and the proportion of early-stage diagnoses has increased, and fewer patients are now diagnosed at late stages. The goal of any screening, including lung cancer screening, is to detect the disease early when it is not causing symptoms and when the treatment will be most successful.
The current recommendation is for low-dose CT, which is based on the results of two very important trials called the National Lung Screening Trial (NLST) as well as the NELSON trials. These trials showed that lung cancer screening improved overall survival and likely drove the shift in diagnosis from advanced to early-stage disease.
The screening recommendations have been broadened in order to increase rates of early detection and to increase uptake of lung cancer screening for populations at high risk for lung cancer. Some of the recommendations include broadening or removing the upper age limit. Previously, screening was recommended for ages 55-74, but now the American Cancer Society recommends annual low-dose CT screening for individuals aged 50-80 years old.
Eligibility criteria in patients with a smoking history have also broadened. Patients now qualify if they currently smoke, or have ever smoked, regardless of when they quit, with at least a 20-pack-year history (down from 30). Importantly, current smokers should also have access to smoking cessation support.
One thing that we also need to work on is broadening screening for high-risk populations and to also include underrepresented patients.
A study presented at ASCO 2025 demonstrated that in high-risk populations, such as those in the Mississippi Delta, the rates of lung cancer diagnosis and incidental pulmonary nodules were much higher than in the NLST trial — more than fourfold greater than the 1.1% observed — demonstrating the impact of lung cancer screening in the higher risk population.
Certainly there are patients that are still ineligible for lung cancer screening. However, smoking exposure still remains a critical factor to assessing risk and determining a favorable risk-benefit ratio for screening.
For patients with no smoking history, at this time, they are ineligible for lung cancer screening. This goes for individuals younger than age 50 and those who have less than a 20-pack-year smoking history. Also, patients who have risk for secondhand smoke are not eligible for lung cancer screening.
If an individual thinks they are high risk for lung cancer yet do not currently fit the screening criteria, it is important to discuss this with their healthcare provider. They may be eligible for clinical trials evaluating broader screening as we continue to learn more about people at risk for lung cancer.
It is important to note that patients with symptoms suspicious for lung cancer — such as cough or shortness of breath — are not eligible for screening. They should instead undergo a diagnostic CT scan. For those with an abnormal CT scan during screening, radiologists use specific criteria called the Lung-RADS to classify the risk of lung cancer for that individual.
Depending on risk stratification from the radiology findings, patients may be advised to schedule a follow-up sooner than 1 year or, in some cases, to have a biopsy. Many patients with identified lung nodules may be monitored more closely, and some institutions now offer lung nodule clinics to ensure appropriate follow up. Importantly, finding a lung nodule on a lung cancer screening test does not mean the patient will ever develop lung cancer, but it may mean that they need closer monitoring.
Future investigations are required to reduce the risk of high false-positive rates. In clinical trial settings, blood tests are being incorporated to help identify patients at higher risk of lung cancer during screening. I would also like to emphasize the importance of increasing lung cancer screening rates — not only in the US but worldwide.
I believe these are all positive changes and very important for us to address. Thank you very much for listening.