Category: Lung Cancer Screening

The Danger of Incidental Findings in CT Lung Screening

Posted on by Brian Casey

CT lung cancer screening is gaining momentum around the world, but one of the challenges providers face is how to manage incidental findings. It’s especially important given that a new study in JAMA Network Open suggests that incidental findings on screening exams are associated with a higher risk of cancer occurring outside the lung. 

Incidental findings are suspicious areas discovered outside the target region being imaged, and are especially a concern with cancer screening exams.

  • Incidental findings turn out to be normal most of the time, but pathology occurs often enough that most clinicians agree they’re worth investigating. 

The problem is that many providers don’t have a robust system in place for alerting referring physicians to incidental findings and ensuring that patients get the follow-up exams they need.

The new study addresses incidental findings within the context of CT lung cancer screening, specifically in the National Lung Screening Trial, the landmark study that established low-dose CT’s lifesaving benefit.

  • It’s an important question, because chasing down a large number of benign incidental findings would be a resource-intensive task that could alter the cost-benefit ratio of lung screening.

Researchers analyzed significant incidental findings unrelated to lung cancer in 26.4k people across three rounds of LDCT screening who were followed for a year, revealing…

  • Cancer findings outside the lung occurred in 6.8% of people, and 13% of them had multiple cancers. 
  • Patients with significant incidental findings had a higher absolute risk of being diagnosed with extrapulmonary cancer within a year (16 per 1k participants). 
  • Study participants with incidental findings tended to be slightly older (62 vs. 61 years) and more likely to have a history of smoking-related disease (69% vs. 66%).

The findings confirm that having a plan to manage incidental findings should be an important part of any CT lung cancer screening program, especially given previous research showing that 23% of deaths in NLST were due to cancers outside the lung. 

  • In fact, an effective incidental finding program could enhance LDCT screening’s value, especially given that people eligible for screening have heavy smoking histories.

The Takeaway

The new study shows that incidental findings on CT lung screening exams are common and serious enough to warrant further investigation. Screening programs that are able to do so effectively will deliver even more value to their patients than lung screening alone.

Lung Cancer in Non-Smokers Creates Questions

Posted on by Brian Casey

Behind the growing enthusiasm for CT lung cancer screening is a nagging question – should we be screening people who have never smoked too? It’s a dilemma that’s addressed in a new paper in Radiology that offers some insight.

CT lung screening is the only major cancer screening test that’s exclusively targeted at high-risk individuals, essentially people who have smoked long enough to meet inclusion criteria.

  • Other cancer screening exams – for breast, colorectal, and cervical cancer– are offered to broader segments of the population, with age typically the only qualifying factor.

But lung cancer still occurs in people who have never smoked, who account for 10-25% of lung cancer cases, the fifth most common cause of cancer mortality globally.

  • For example, East Asian women, even those who have never smoked, seem to have higher lung cancer incidence rates, indicating a genetic risk factor that’s still not fully understood. 

The new Radiology paper reviews the state of knowledge regarding lung cancer in people who have never smoked, and examines whether the phenomenon’s prevalence calls for a rethinking of how CT lung cancer screening is offered. 

The authors explain that lung cancer in non-smokers…

  • Can be caused by environmental factors like workplace exposure, air pollution, genetic susceptibility, and exposure to second-hand smoke (20-26% higher risk for spousal exposure).  
  • Has a different carcinogenesis mechanism than lung cancer in smokers, and tends to be more slow-growing.
  • Has different characteristics than cancer in smokers, being overwhelmingly dominated by adenocarcinoma (90%). 

So with this knowledge in hand, should current U.S. and European lung cancer screening guidelines be changed? 

  • Japan is already conducting mass lung screening regardless of smoking history, while China’s guidelines include people who have never smoked but have other risk factors like occupational exposure.

But broader screening could lead to higher rates of overdiagnosis and overtreatment, and early studies from Asia have found screening had little effect on overall mortality in non-smokers. 

  • That led the Radiology authors to conclude that, at present, it’s probably not advisable to begin screening people who have never smoked until more research is conducted.

The Takeaway

The new paper on CT lung cancer screening of people who have never smoked is more than just an interesting thought experiment. It surfaces an issue that’s been percolating as risk-based lung screening gains momentum, and that ultimately may require a completely different approach to lung screening from what’s been used to date.

CT Lung Screening News from WCLC 2025

Posted on by Brian Casey

The World Conference on Lung Cancer wrapped up this week in Barcelona, and CT lung cancer screening was a highlighted topic, as it was at WCLC 2024 in San Diego.

The last year has seen significant global progress toward new population-based lung screening programs, and sessions at WCLC 2025 highlighted the advances being made… 

  • A screening program serving Kentucky and Indiana since 2013 has seen a 30-percentage-point decline in late-stage lung cancer diagnoses – over 3.5X faster than national trends – with far higher uptake than national averages (52% vs. 16%).
  • In the European 4-IN-THE-LUNG-RUN trial, AI had a negative predictive value similar to radiologists (98% vs. 97%) in analyzing 2.2k CT lung screen exams, indicating its potential as a first reader.
  • Another 4-IN-THE-LUNG-RUN study of 2.6k individuals revealed that AI had a 2.5% incidental findings rate, with none having acute consequences after a year.
  • The USPSTF’s 2021 guideline expansion may have reduced the number of at-risk individuals eligible for screening. A California analysis of 11.7k lung cancer patients found 8.8% fewer patients were eligible.
  • Researchers from Illinois found that basing screening eligibility on a 20-year smoking history rather than USPSTF 2021’s 20-pack-year threshold would capture more eligible individuals (70% vs. 65%), especially racial minorities.
  • A screening program at a VA healthcare system in Northern California achieved a 94% adherence rate for 3.9k military veterans, with 67% of cancers diagnosed at early stages.
  • U.S. military veterans had much higher screening rates (50% vs. 29%) in an analysis of 413.6k cancer survivors. Among women, 71% were up to date on mammography screening but only 25% were current for lung screens. 
  • Researchers used Qure.ai’s algorithm to detect malignant pulmonary nodules on 198k routine chest X-rays in a tuberculosis screening program.
  • Asian American women are at higher risk of lung cancer – even if they don’t smoke – and a session explored whether they should be screened.
  • A Stanford University program using electronic alerts to primary care physicians boosted screening compliance after one year (16% vs. 8.9%).
  • Attending lung screening didn’t make people feel they had a “license to smoke” in a U.K. study of 87.8k people.
  • Italian researchers tested Coreline Soft’s AVIEW AI solution as a first reader for screening.

The Takeaway

Findings from this week’s WCLC 2025 conference show both the challenges and opportunities in CT lung cancer screening. Researchers around the world are demonstrating that with hard work, dedication, and persistence, lung screening can become an effective, life-saving exam.

AI-Driven Lung Cancer Screening and Improving Patient Outcomes

Posted on by Partner Content

AI is reshaping clinical decision-making, optimizing resource allocation, and enhancing both patient outcomes and experience in CT lung cancer screening. Radiology providers are successfully integrating new AI software tools into hospital operations – supporting diagnostic accuracy and improving patient outcomes.

At the center of this trend is Coreline Soft’s FDA-cleared AVIEW LCS Plus, a 3-in-1 solution capable of detecting lung nodules, quantifying emphysema, and analyzing coronary artery calcification – all from a single low-dose CT scan. 

  • AVIEW LCS Plus is in use at Temple Health, a nationally recognized institution in the U.S. Northeast, where it has allowed providers to streamline clinical workflows from detection to follow-up, delivering measurable improvements in care and ROI.

Coreline Soft will co-host a strategic webinar with the Temple Lung Center on August 1 at 1:30 PM ET, focused on AI-powered lung cancer screening and the evolving paradigm of early detection for chest diseases.

The webinar will offer firsthand insight into how Temple Health is drawing attention as a model for integrating AI beyond diagnosis – transforming it into a scalable, patient-centered care strategy.

The discussion will focus on two main areas…

  • Real-world outcomes: How AI improved diagnostic efficiency, early detection, and comorbidity detection.
  • A deep dive into the precision technology of the AVIEW LCS Plus platform.

AI like Coreline’s is not replacing clinical judgment, but reinforcing it, enhancing radiologists’ ability to detect, triage, and treat lung disease earlier and more efficiently, Criner believes. 

  • The webinar is open to pulmonologists, radiologists, cardiologists, respiratory-adjacent professionals, hospital stakeholders and administrators, and primary care providers across the U.S. and Canada. Interested participants can register for free in advance via the official registration link. 

The Takeaway

AI solutions like Coreline Soft’s AVIEW LCS Plus platform are having a real-world impact on healthcare providers as they roll out CT lung cancer screening programs. Sign up to learn more on August 1.

Are CT Lung Screening Patients Sicker?

Posted on by Brian Casey

Amid the rush of enthusiasm for CT lung cancer screening, a new study published in JAMA Health Forum offers a cautionary note. Researchers found that in the real world, people eligible for lung screening were sicker than those in research studies, and thus may not enjoy screening’s benefits to the same extent. 

Support for CT lung cancer screening is based on randomized controlled trials published in 2011 (NLST) and NELSON (2020) that showed screening reduced lung cancer mortality among high-risk individuals who typically had long smoking histories. 

  • The studies have spurred momentum for large-scale CT lung cancer screening programs, with a number of European and Asian countries starting national initiatives. 

But how generalizable are these results? Researchers noted that people who participated in the NLST study tended to be younger and healthier than individuals who qualify for screening in the real world. 

  • Co-morbidities like COPD, diabetes, and heart disease, as well as age and racial background, can have an impact on survival after treatment for lung cancer, and thus could reduce screening’s risk/benefit calculation. 

In the new Personalized Lung Cancer Screening study, researchers analyzed the comorbidity profiles of 31.8k people who got screened between 2016 and 2021 in California, Florida, and South Carolina. 

  • They noted that their PLuS study cohort was more diverse in terms of age, race, and ethnicity than that used in NLST, and potentially had more comorbid conditions. 

In analyzing their population, PLuS researchers found that compared to NLST participants, people screened in their real-world programs had …

  • Higher rates of COPD (33% vs. 18%).
  • Higher rates of diabetes (25% vs. 9.7%).
  • Higher rates of heart disease (16% vs. 13%).
  • Were more likely to be aged 70 and over (25% vs. 8.8%).
  • Had high scores on various metrics of comorbidity and frailty. 

Older, sicker patients are less likely to have good health outcomes after lung cancer surgery, and might also succumb to conditions like COPD, diabetes, and heart disease before lung cancer, which could also reduce lung screening’s benefits.

The Takeaway

While the new findings aren’t likely to seriously dampen CT lung cancer screening’s growing momentum, they do illustrate a point that should always be kept in mind when looking at research results: in the real world, your mileage may vary. 

CT Lung Screening’s Weak Link

Posted on by Brian Casey

CT lung cancer screening rates in the U.S. remain abysmally low, over a decade after the exam was recommended. Is part of lung screening’s problem its reliance on provider referrals? A new research letter in JAMA Network Open examines this question. 

Unlike breast screening, in which eligible women are able to self-refer themselves for exams, CT lung screening revolves around provider referrals to start the process. 

  • CMS requires a shared decision-making session that results in a written order from a practitioner for a CT lung screening exam in order to pay for screening through Medicare and Medicaid. 

When CMS created the rules in 2015, provider referrals and shared decision-making were seen as ways to get patients involved in their own care by making choices in coordination with their caregivers.

  • But many are starting to see the requirements as a barrier, especially given low CT lung screening rates in the U.S.

In the new article, researchers investigated how easy it would be for an eligible individual to secure a CT lung screening appointment by just calling hospitals – without a provider referral. 

  • They note that one-third of Americans don’t have primary care clinicians, and are often told to call hospitals directly to set up appointments.

So they did just that, placing phone calls to 527 hospitals asking to arrange CT lung screening appointments, finding …

  • 317 calls (60%) failed because the caller did not have a primary care provider’s order.
  • Only 51 hospitals (9.7%) were able to connect callers to any component of a lung cancer screening process. 

The study authors note that the provider referral requirement isn’t the only thing holding CT lung cancer screening back, as even patients with primary care providers aren’t getting screened, and managing nodule follow-up can also be challenging. 

  • But Medicare’s cumbersome reimbursement rules certainly don’t help bring new people into the fold.

The Takeaway

Given CT lung cancer screening’s undisputed life-saving value, there’s no reason to put unnecessary barriers in its way. The provider referral and shared decision-making requirements are lung screening’s weak link to securing greater adoption, and CMS should rescind them to put CT lung cancer screening on the path to greater adoption.

Lung Screening’s Star Turn at WCLC 2024

Posted on by Brian Casey

The World Conference on Lung Cancer (WCLC) is underway in San Diego this week, and CT lung cancer screening has had a starring role at the meeting. The sessions come as lung screening continues to build momentum through 2024. 

Low-dose CT lung screening got the green light from the USPSTF over a decade ago, but screening rates are still mired in the single digits in many regions. 

  • The evidence backing LDCT’s life-saving value has been building, however, and around the world countries are launching national screening programs to counter the smoking epidemic, the leading cause of preventable cancer death worldwide.

Sessions at WCLC 2024 have highlighted this progress, with many speakers focusing on ways to boost screening compliance or use tools like AI to detect more lung cancers. 

Presentations on early lung cancer detection have included the following findings… 

  • Three years of lung screening starting in 2021 in Quebec produced a lung cancer detection rate of 1.6% in the first screening round, with 85% of cancers stage I or II.
  • Advanced practitioner nurses are being trained in Australia to assess pulmonary nodules to alleviate workforce challenges when the country’s national lung screening program starts in July 2025. 
  • Using Coreline Soft’s AVIEW algorithm to read baseline LDCT exams helped BioMILD researchers move to a triennial screening interval without missing cancers. 
  • The QUILS system for lung cancer quality assurance helped assess quality across multiple LDCT screening sites in Kentucky.
  • Over 10 years in which 2.3k patients were scanned, researchers found a 3.7% lung cancer detection rate and 100% survival for early-stage cancer.
  • Among 4.2k patients, those who got screened had more stage I-II disease (72% vs. 37%) and higher rates of surgery-only treatment (56% vs. 25%) at three years. 
  • Using PanCan criteria to manage suspicious lung nodules worked better than Lung-RADS in 4.5k people screened, with fewer workup referrals (2.8% vs. 7.4%) and better PPV for high-risk malignancy (48% vs. 18%).

The Takeaway

This is just a selection of the exciting research being presented at WCLC 2024. It seems evident that CT lung screening’s future as a mainstream cancer test is closer than ever.

AI Powers Two-for-One Screening

Posted on by Brian Casey

In our last issue, we described how effective coronary artery calcium scoring is in predicting future major adverse cardiovascular events. This week, we’re highlighting new research in AJR showing how – thanks to AI – CAC scoring can be performed on CT lung cancer screening exams, giving radiologists a two-for-one screening test.

Using data from one screening exam to also look for other diseases – known as opportunistic screening – has become a hot topic as a way to make screening even more clinically and economically effective. 

In the new study, South Korean researchers leveraged the country’s CT lung cancer screening program to also screen for CAC, a known marker for future cardiac events. 

  • They took two commercially available CAC scoring algorithms – Coreline Soft’s Aview CAC and Siemens Healthineers’ syngo Calcium Scoring – to analyze 1k low-dose CT chest images acquired from 2017-2023 as part of the national lung screening program. 

AI results were compared to radiologists’ interpretations of CAC presence and severity, finding … 

  • Substantial agreement between both the AI algorithms and the interpreting radiologists for CAC presence and severity (kappa=0.793 & 0.671)
  • The AI algorithms judged CAC to be more prevalent than radiologists (57-60% vs. 53%)
  • AI was more likely to judge CAC severity as mild (35-40% vs. 28%)
  • But less likely to grade it as severe (6.2%-7.3%  vs. 15%)
  • MACE incidence varied by CAC severity: no CAC (1.1-1.3%), mild (3-5%), moderate (2.9-7.9%), and severe (8.6-11%)

The researchers noted that, as with other studies, MACE incidence increased with CAC severity, underlining the importance of coronary calcium evaluation and supporting the use of CT lung screening for CAC detection. 

The Takeaway

Studies like this highlight the exciting role AI can play in making opportunistic screening a reality. With AI at their side, radiologists will be able to play an even more important role in catching disease early, when it can be treated most effectively.

CT Lung Screening’s Downstream Costs

Posted on by Brian Casey

The growing momentum of CT lung cancer screening was a major radiology news story in 2023. And while things are looking up as 2024 begins, there are still important issues to be sorted out for CT lung screening to achieve the same level of acceptance as other major cancer screening tests. 

A new study called PROSPR in Annals of Internal Medicine highlights some of these challenges. 

  • Researchers found a higher rate of invasive procedures and complications after CT screening compared to the National Lung Screening Trial, the landmark study that showed that low-dose CT screening reduces lung cancer mortality by 20%. 

The PROSPR researchers studied 9.3k individuals who got baseline LDCT lung screening scans from 2014 to 2018 across five US healthcare systems, finding: 

  • Abnormalities on baseline CT scans for 1.5k individuals (16%)
  • Of these, 9.5% were diagnosed with lung cancer within 12 months 
  • A 32% rate of downstream imaging of screened individuals 
  • A 2.8% rate of invasive procedures such as needle biopsy and bronchoscopy 
  • In those who got invasive procedures, rates were higher than NLST for all complications (31% vs. 18%) and for major complications (21% vs. 9.4%)

What gives with the higher complication rates? 

  • One explanation is that the PROSPR population was older and sicker than in NLST, with more individuals 65 and over (52% vs. 27%) and higher rates of current smoking (55% vs. 48%) and COPD (35% vs. 18%). 

Another reason could be that PROSPR’s population was more racially diverse, with fewer Whites than NLST (73% vs. 91%) and with a higher proportion of women (47% vs. 41%) – a sign of healthcare disparities. 

The PROSPR authors acknowledged that their findings could shift the debate over the benefits and harms of CT lung cancer screening in community practice – a debate that has raged in breast screening for decades.

The Takeaway

The PROSPR findings are something of a wake-up call amid the growing enthusiasm worldwide for CT lung cancer screening. It’s no surprise that real-world results will differ from the highly controlled environment of a clinical study like NLST, but lung screening proponents will need to be prepared with a plan for managing downstream findings and a response to screening skeptics who would use results like PROSPR to question whether lung screening should be performed at all.

Lung Screening’s Long-Term Benefits

Posted on by Brian Casey

CT lung cancer screening produced lung cancer-specific survival over 80% in the most recent data from the landmark I-ELCAP study, a remarkable testament to the effectiveness of screening. 

The findings were published this week in Radiology from I-ELCAP, one of the first large-scale CT lung screening trials, and are the latest in a series of studies pointing to lung screening’s benefits. The findings were originally presented at RSNA 2022. 

The I-ELCAP study is ongoing and has enrolled 89k participants at over 80 sites worldwide from 1992-2022 who have been exposed to tobacco smoke and who received annual low-dose CT (≤ 3mGy) scans. Periodic I-ELCAP follow-up studies have documented the survival rates of those whose cancers were detected with LDCT, and the new numbers offer a 20-year follow-up, finding: 

  • Primary lung cancers were detected on LDCT in 1,257 individuals who had lung cancer-specific survival of 81%, matching the 10-year survival rate of 81%
  • 1,017 patients with clinical stage I lung cancer underwent surgical resection and saw a lung cancer-specific survival rate of 87%
  • The I-ELCAP survival rate is much higher than another landmark screening study, NLST, in which it was 73% for stage I cancer at 10 years
  • Lung cancer-specific survival hit a plateau after 10 years of follow-up, at a cure rate of about 80%

I-ELCAP is unique for a variety of reasons, one of which is that it continues to screen people beyond a baseline scan and 2-3 annual follow-up rounds – perhaps the reason for its higher survival rate relative to NLST. 

  • It also has included people who were exposed to tobacco smoke but who weren’t necessarily smokers – an important distinction in the debate over how broad to expand lung screening criteria.  

The findings come as CT lung cancer screening is generating growing momentum. Studies this year from Germany, Taiwan, and Hungary have demonstrated screening’s value, and several countries are ramping up national population-based screening programs. 

The Takeaway

The 20-year I-ELCAP data show that CT lung cancer screening works if you can get people to do it. But achieving survival rates over 80% also requires work on the part of healthcare providers, in terms of defined protocols for working up findings, data management for screening programs, and patient outreach to ensure adherence to annual screening. Fortunately, I-ELCAP offers a model for how it’s done.

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