Let’s Focus on Lung Health Screening, Not Just Lung Cancer Screening
Deborah Stahlnecker, D.O., FCCP
Chief of Pulmonary Medicine Director
Interventional Pulmonary
St. Luke's University Health Network
Despite lung cancer being responsible for more cancer-related deaths than colon, prostate or breast cancers,1 the screening rate of those eligible is estimated at 18%.2
Yet, those who are eligible but have never undergone a lung cancer screening are being screened for breast cancer (60.2%) and colorectal cancer (58.7%), according to a recent study.3 Colonoscopies and mammograms have become commonly accepted as routine health screenings. Why isn’t lung cancer screening seen by smokers and former smokers as routine?
Researchers cite barriers that include the lack of a primary care provider and lung cancer screening eligibility guidelines that are too complicated. In my experience, I’d argue that a major factor in the low screening rate is largely because we just aren’t reaching enough patients with the basics.
So, when we do connect with a patient, let’s keep the message simple, focus on education and, frankly, be persistent.
Many screening guidelines are simple: mammograms beginning at age 40 every two years for those at average risk, and colonoscopies beginning at age 45 every 10 years for those at average risk.
While lung cancer screening guidelines are not based on age alone, I would argue that they’re not terribly complicated: a low-dose chest CT (LDCT) scan beginning at age 50 for current smokers or those who have quit in the last 15 years and smoked the equivalent of a pack a day for 20 years. Current guidelines suggest screening until age 80.
Unlike a colonoscopy, there’s no prep involved, and a CT scan takes only a few minutes. It is quite simple.
There will be some patients who exhibit a kind of fatalism, a feeling that they’ve brought the possibility of lung cancer onto themselves following years of smoking, so they don’t want to bother with screening. We need to frame that occasional mindset with the message that they’ve quit smoking, which is the best thing they could have done for themselves. Now, let’s see what, if any, footprint smoking has left behind.
Primary care providers often represent the frontline in spreading the word about lung cancer screening. It is important that they become familiar with the guidelines and communicate the importance of screening to their patients.
A patient who qualifies for an LDCT may have other more immediate health needs that end up pushing preventive care down the to-do list. So, we need physicians to be persistent and not lose sight of the importance of lung cancer screening.
“We must take the opportunity to have an “educational moment” with our patients, who may be surprised to learn that just because they stopped smoking several years ago doesn’t mean they are no longer at risk for lung cancer. For some, there may be a physical fear of screening, envisioning an MRI that can take 45 minutes in a metal tube. Demystify the process. Education, education, education.
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We must take the opportunity to have an “educational moment” with our patients, who may be surprised to learn that just because they stopped smoking several years ago doesn’t mean they are no longer at risk for lung cancer. For some, there may be a physical fear of screening, envisioning an MRI that can take 45 minutes in a metal tube. Demystify the process. Education, education, education.
Stress the importance of early screening. Lung cancer has a low 5-year survival rate because most lung cancer is diagnosed late in the disease process, at Stage 3 or 4.2 Early detection means more treatment options. Let’s take the fear out of screening. Just because we’re looking for cancer doesn’t mean we’re going to find it. Let’s just be sure.
And maybe lung cancer screening is due for a bit of a re-brand. Let’s discuss with our patients that screening can help to assess for “lung health,” not just lung cancer.
There’s growing data that lung cancer screening images are offering a wealth of other information such as coronary artery calcification scores. We may also identify emphysema and other smoking related lung diseases that may warrant treatment. Scans can also identify osteoporosis and osteopenia.
We can glean a great deal from a lung screening, so let’s help our patients understand the rationale and benefits of a health screening. Education, education, education.
Does an LDCT scan expose a patient to low levels of radiation? Can a scan turn up something that’s not cancerous but still requires additional tests? Yes, and yes. However, we must also remember that these risks are outweighed by the fact that lung cancer screening saves lives, decreasing lung cancer related deaths by 20%.4
In other words, a lung cancer screening has its pros and cons like any other preventive care. Regardless, let’s have that conversation with our patients. Let’s discuss how the benefits can outweigh the possible drawbacks. We’re not going to convince every patient who qualifies to undergo lung cancer screening, but we cannot let people go unscreened because they don’t have the necessary information to make an informed decision. Education, education, education.
One way to make progress is to link lung cancer screening education with smoking cessation programs. People who might qualify for lung cancer screenings are in front of us because they want to quit smoking. It’s a logical combination of efforts, and patients are more open to the idea of screenings once they take that step to kick the habit of smoking.
In the spirit of simplicity, let’s look for other avenues to connect with existing patients who are keen on preventive care. When lung cancer screening criteria expanded in 2021, researchers surveyed patients at two medical centers who were undergoing screening mammography to determine their eligibility and interest in lung cancer screening.
The results showed less than half of the eligible women had heard of lung cancer screening but nearly three-quarters of them were very interested once they had the facts.5 Education, education, education.
If we do manage to educate more patients, let’s try our best to simplify and streamline the process, which is where nurse navigators can play a significant role.
Nurse navigators can help patients coordinate transportation and insurance coverage. In the event of an abnormal finding, they can facilitate the necessary follow-up tests and appointments. They can connect the dots between all the necessary specialties, ensuring they do not get lost in the often-complicated healthcare system. In the event of a negative screening, navigators can maintain a database to make sure a patient comes back the following year, assuring screenings don’t get lost in the shuffle of a patient’s other healthcare needs.
The guidelines for lung cancer screenings aren’t perfect and will likely continue to evolve, qualifying a more diverse population for screenings. Until then, we must continue to educate our patients, make LDCT accessible, invest in nurse navigators, and make connections between services where they can be most effective.
And if it takes some persistence, so be it. I’d rather talk to a patient about lung cancer screening a dozen times than talk to them once about a lung cancer diagnosis.
1. National Cancer Institute, SEER Program, “Cancer Stat Facts: Common Cancer Sites.”
2. American Lung Association, “State of Lung Cancer 2024; Lung Cancer Key Findings.”
3. Potter AL, Kothagundla S, Haridas C, Chang AEB, Sequist LV, Yang CJ. “Preventive Health Care Use Among Adults Eligible for Lung Cancer Screening in the US.” JAMA. Published online April 02, 2025. doi:10.1001/jama.2025.2157
4. National Cancer Institute, “Lung Cancer Screening Saves Lives: The National Lung Cancer Screening Trial”
5. Novogrodsky, E; Haramati, LB; et al, “Lung Cancer Screening Among Mammography Patients: Knowledge, Eligibility, Participation, and Interest.” J Am Board Fam Med. 2023 Aug 9;36(4):557-564. doi: 10.3122/jabfm.2022.220423R1. Epub 2023 Jun 15. PMID: 37321658.
