Lung Cancer Screening Lags Amid Low Awareness and Health Access

PHOENIX — Lung cancer screenings have continued to lag behind other types of cancer screenings, due in part to a communication gap in which few people eligible for screening are discussing their risk with clinicians, according to findings presented at CHEST, the annual meeting of the American College of Chest Physicians, in Phoenix on October 20.

“Addressing these deficits at multiple points along the screening continuum is essential to improve lung cancer screening uptake and reduce mortality, “ Sarvesh Sharma, MD, a fellow of pulmonary disease and critical care medicine at Cape Fear Valley Medical Center and a clinical instructor at Methodist University Cape Fear Valley School of Medicine in Fayetteville, North Carolina, told attendees.

“Lung cancer screening saves lives. This has been proven over and over again,” Sharma said. A gradual increase in rates — from 12.8% in 2019 to 24.5% in 2024 — shows that progress is possible, “but we still have a long way to go,” he said. Both awareness of lung cancer screenings and discussions about lung cancer risk remain very low among patients.

“Most eligible patients won’t bring up smoking history, let alone lung cancer screening, themselves,” Sharma said. “That means clinicians have to start the conversation. For every adult aged 50-80, we should take an accurate smoking history that includes pack-years and quit date and then offer screening to those who qualify.”

He advises clinicians to look at their own patients and how their lung cancer is being identified. “If nodules are mostly being found late and incidentally, that likely points to a screening gap, and that gap can be fixed,” he said.

Lung cancer remains the leading cause of US cancer deaths, responsible for approximately 125,000 deaths each year. Low-dose CT lung cancer screening, which has been recommended by the US Preventive Services Task Force for a decade, reduces lung cancer mortality by an estimated 20%-24% among high-risk adults.

The researchers conducted a cross-sectional analysis of publicly reported 2022 US surveillance data among adults aged 50-79 who have a history of at least 20 pack-years and are currently smoking or have quit within the past 15 years. Their data sources were the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention and the American Lung Association 2022 Lung Health Barometer.

Among an estimated 13.17 million adults, only 38% were aware that lung cancer screening was available, and only 27% had discussed their risk of lung cancer with a clinician. Overall, 18.1% of adults had completed lung cancer screening, leaving an estimated 82% of eligible adults unscreened.

That screening rate is substantially lower than the estimated 76.6% of women aged 50-74 who underwent breast cancer screening and the 61.4% of adults aged 45-75 who underwent colorectal cancer screening in 2022.

Sharma noted that access to care strongly influences uptake: 19.7% of eligible adults with a usual source of care were screened for lung cancer compared to 5.1% of those without a usual source of care. People with Medicare had the highest screening rates (26.3%), followed by Medicaid (16.2%) and private insurance (14.4%), compared to 3.7% of people without insurance.

“Patients without insurance or a regular source of care are screened the least, so they need the most deliberate outreach,” Sharma said. He said that improving national rates will require action at every level.

“For individual clinicians, lung cancer screening should be part of routine preventive care, discussed as naturally as mammograms and colonoscopies,” Sharma said. “Health systems can support this with electronic health record prompts that flag eligible patients, nurse navigators who guide patients through the process, and organized screening programs that track results and make sure patients come back each year.”

At the policy level, Sharma said it is necessary to expand insurance coverage, reduce the cost of follow-up care, and support mobile- and community-based screening in rural and underserved areas.

“Pulmonologists can’t close this gap alone,” he said. “Primary care, hospital medicine, emergency medicine, and every other specialty has a role.”

Arooj Kayani, MD, a pulmonologist and critical care physician at Tempe Medical Center and HonorHealh Scottsdale Osborn Medical Center in Tempe, Arizona, who was not involved in the research, told Medscape Medical News that she was unfortunately not surprised by the findings, particularly given that past evidence has shown people who smoke often have lower rates of other cancer screenings as well.

“The thought is that patients who have not gone for lung screening are more likely to be the patients who did not go for any cancer screening,” Kayani said. Another possible reason for the big gap is that breast and colorectal cancer screening guidelines are much simpler than those for lung cancer screening, she said. Both breast and colorectal cancer screening have universal screening with clear age cut-offs.

“For lung cancer, the guidelines are complicated,” she said. “You have to identify the smokers. You have to quantify their duration. You have to quantify how much they smoked. You have to figure out when they quit, if they have quit.”

Patients may or may not be forthright about their smoking history, she added, and obtaining all this history to qualify patients for lung cancer screening takes time.

“Not every provider is willing to spend that kind of time and identify that patient population and have that conversation,” Kayani said. She noted that simplifying the guidelines might help move the needle, but another challenge is the growing population of women who do not smoke but are presenting early for lung cancer without any risk factors.

“We still don’t have any guidelines to screen those women,” she said, though some countries are working on guidelines for them.

Overall, though, Kayani sees simplifying the criteria for screening as one of the steps that might help in closing the gap in screening. “If we can make the guideline simpler, we can invest that time in making sure patients qualify,” she said.

No external funding for the research was noted. Sharma had no disclosures. Kayani is a consultant for Intuitive. 

Tara Haelle has been an independent science/health journalist for over 15 years, with work appearing in over two dozen trade and consumer publications. She is author of Vaccination Investigation: The History and Science of Vaccinesand The Informed Parent: A Science-Based Guide to the First Four Years. Tara is the Public Health Beat Leader for the Association of Health Care Journalists, where she develops resources to help other journalists report on medical studies and public health. She is based in Dallas, Texas.