Category: Lung Cancer Screening

Better Lung Screening Strategies

Posted on by Brian Casey

In our last issue, we discussed how CT lung cancer screening is falling short, mostly because so many eligible people still aren’t getting screened. In this issue, we offer strategies for fixing the problem, based on studies published last week in JACR. 

A lung cancer diagnosis was once thought of as a death sentence, as it was usually diagnosed at a late stage.

  • But that dynamic has changed with low-dose CT screening, which detects cancers small enough to be effectively treated – as was the case with Pope Leo XIV earlier this month. 

But uptake of LDCT screening has been slow, with U.S. screening rates below 20% for eligible people – compared to nearly 80% for mammography. 

  • The new JACR articles include three studies that cover a range of relevant topics in screening, from boosting participation rates to ensuring quality in screening programs. 

In the first study, researchers described their LungCheck program for boosting LDCT rates. 

  • LungCheck focuses on outreach to primary care providers with educational materials and meetings that explain screening eligibility criteria, as well as patient navigators for follow-up and scheduling and EHR modifications to capture eligible people.

Across 5.9k people, LungCheck led to almost 3X higher odds of an eligible person getting LDCT screening at academic centers (OR = 2.67), and almost 5X at federally qualified health centers (OR = 4.53).

The second JACR study specifically addresses outreach to Hispanics, a traditionally underserved population for LDCT screening. 

  • Researchers analyzed the effectiveness of their Empower LCS program, which included a culturally adapted decision aid, provider notifications, and patient text reminders. 

While the sample size of 60 patients was small, there were significantly higher ordering rates for patients in Empower LCS at four months than usual care (50% vs. 13%), as well as more lung screening discussions (40% vs. 17%). 

  • There was a trend toward greater completion of LDCT screening exams, but the difference wasn’t statistically significant, probably due to the small sample size (30% vs. 13%, p = 0.117). 

In the third paper, researchers assessed how well the ACR’s Lung Cancer Screening Registry mapped to IASLC quality measures.

  • While 69% of IASLC measures mapped to registry data, 31% didn’t line up, especially data on patient entry, treatment, and wait times. 

The Takeaway

The new JACR studies show the promising advances being made to boost CT lung cancer screening participation, while also helping imaging facilities improve the quality of their service. All that’s left to do is to put these promising ideas into broader practice.

One-Stop CT Chest Screening

Posted on by Brian Casey

Could opportunistic screening be driving the evolution of low-dose CT from a screening test just for lung cancer into a broader one-stop exam for multiple chest pathologies? A new study in JACR suggests as much – and provides a blueprint for how to do it. 

There’s no question LDCT lung cancer screening is gaining traction around the world. But as screening programs are starting, clinicians are finding that CT scans can detect far more than just lung cancer. 

  • Emphysema, commonly associated with COPD, is one such condition, as it goes hand-in-hand with lung cancer in people with long smoking histories. Another is coronary artery calcium (CAC), a known risk factor for cardiovascular disease. 

In the new study, researchers wanted to investigate the prevalence of COPD and CAC in their LDCT screening program covering three hospitals in the NewYork-Presbyterian system. 

  • In addition to documenting prevalence rates, they wanted to connect clinical outcomes to social determinants of health, which have been demonstrated to affect patient care. 

They tracked results from 2.4k people who got baseline LDCT scans from 2015 to 2022, finding…

  • Emphysema was detected in 77% of patients, and CAC in 65%.
  • 87% of patients with emphysema had no previous diagnosis.
  • The proportion of patients getting pulmonary care after their LDCT scan increased (from 24% to 46%), as did the rate of those getting cardiovascular care (from 43% to 63%).  
  • Lower household income was associated with 57% higher adjusted odds of emphysema, and food insecurity with 52% higher odds. 
  • No social determinants of health were associated with CAC burden.

It’s worth noting that the study did not use any IT tools to classify COPD and CAC, like AI image analysis or longitudinal tracking and reporting. 

  • It’s entirely possible that the results could be even more promising given the plethora of algorithms that have become available for opportunistic screening applications. 

The Takeaway

The new study on incidental CAC and emphysema findings on LDCT exams shows that lung screening has the potential for opportunistic disease detection even if you don’t have fancy AI algorithms at your disposal. All you need are radiologists and clinical staff dedicated to providing better patient care. 

Expanding CT Lung Screening at WCLC 2026

Posted on by Brian Casey

Low-dose CT lung cancer screening appears set to be the next major population-based cancer screening exam. But much work remains to make LDCT screening available to as many eligible people as possible while optimizing scanning protocols.

That’s according to sessions at IASLC’s World Conference on Lung Cancer (WCLC 2026), which just wrapped up in Seoul, South Korea. 

  • WCLC 2026 sessions ranged from expanding scanning to people at high risk but without smoking histories to using AI to not only detect and characterize lung nodules but to predict future cancer risk.

Some of the key findings from WCLC 2026 included…

  • Australia started its national LDCT screening program in 2025, and researchers expect a national-level stage shift to earlier diagnosis. At a 50% participation rate, stage I diagnoses should grow from 32% currently to 42% for women and 43% for men. 
  • The Ready to Screen (R2S) trial in Australia found that of 1.7k eligible screening candidates surveyed, 85% “definitely” intended to get screened and 26% said they had already received an LDCT scan. 
  • Taiwan’s national screening program showed that – at least in East Asia – people with a family history of lung cancer should be screened. Of 2.8k cancers detected, there was a 74% higher detection rate in those with family histories versus smoking histories (18 vs. 10 cancers per 1k screened), with more early-stage cancers detected (92% vs. 83%).
  • An LDCT screening program in China screened 6.7k people – including those with risk factors besides smoking – finding a 56% lung cancer mortality reduction.  
  • French clinicians successfully added smoking cessation therapy to their LDCT program, with 88% screening attendance and participants 44% less likely to smoke.
  • MIT’s Sybil AI algorithm was more accurate than Lung-RADS in predicting one-year cancer risk from suspicious nodules, with higher AUC when applied to two large lung screening trials (NLST and P-IELCAP). 
  • Researchers found that applying Sybil to coronary artery calcium scans could also predict lung cancer risk for both smokers and non-smokers over a 15-year follow-up period.
  • Researchers used Softek Illuminate’s Illuminate AI software for identifying incidental pulmonary nodules as a complement to an LDCT screening program, finding that the algorithm discovered more lung cancer cases than conventional screening. 

The Takeaway

This week’s WCLC 2026 sessions point out the rapid progress being made around the world in expanding access to LDCT lung cancer screening – as well as the role that AI-based software tools can play in making screening more effective and more widely accessible. 

CT Lung Screening Variation

Posted on by Brian Casey

Adoption of low-dose CT lung cancer screening is growing, and that’s a good thing. But rising LDCT utilization is also creating new challenges, illustrated by a new study in JACR that found high variability in radiologist interpretations. 

CT lung screening participation rates are rising, from single digits a decade ago to 19% in a recent survey. 

  • But there’s still a long way to go to get lung screening to the roughly 75% participation rate seen with breast cancer screening. 

One barrier to getting more people screened is false positives, which can cause patient anxiety and trigger a cascade of additional exams and procedures to work up suspicious findings. 

  • A major contributor to false positives may be variability in how radiologists read CT scans, so the JACR researchers investigated how interpretations for the same images changed between imaging specialists. 

Researchers looked at interpretations made by 1.4k radiologists, each of whom read a minimum of 50 LDCT screening exams (a total of 200k exams), then calculated false-positive rates for both baseline and follow-up exams. Researchers found…

  • High variability in false-positive rates, from 11% to 22%.
  • In random pairs of radiologists, on average, one radiologist would have twice the odds of making a false-positive call as the other. 
  • Radiologists with false-positive rates higher than the median rate also unsurprisingly had higher sensitivity than those below the median (97% vs. 92%).

What’s causing the variation? It could be because some radiologists use image interpretation patterns that increase false positives but also catch more cancers. 

  • In statistical terms, researchers found that for baseline screens read by radiologists who were below the median false-positive rate, they would have about 100 fewer false-positive screens for one fewer true-positive cancer. 

Radiologist variability could be reduced through programs to standardize screening interpretation, such as those implemented in mammography screening.

  • These could include support tools, automated feedback systems, educational interventions, and targeted double reading.

The Takeaway

The new findings on radiologist variability in reading CT lung cancer screening exams illustrate the delicate balance between detecting more cancer at the risk of producing additional false positives. Is the tradeoff worth it? We think we know how most patients would feel.

Lung Cancer Mystery in Non-Smokers

Posted on by Brian Casey

One of the emerging mysteries around lung cancer is why it occurs so often in people who don’t smoke – particularly in Asia. A new paper in JAMA Network Open investigates the phenomenon by presenting results from South Korea indicating that established screening criteria would have missed nearly two-thirds of lung cancer patients.

From its earliest days, CT lung screening has been targeted at heavy smokers who have the greatest chance of developing lung cancer.

  • Risk-based criteria determine who should be screened, usually based on some metric of smoking history (such as the USPSTF’s 20-pack-year threshold).

But many countries that have had national lung screening programs in place for a while – mostly in Asia – are learning that lung cancer also occurs in people who have never smoked at all. 

  • Whether and how to screen these individuals has become the subject of debate. 

In the current study, researchers from South Korea examined 89.9k patients who were diagnosed with lung cancer from 2013 to 2018, just before the country started its national lung screening program in 2019. 

  • Researchers focused on whether patients would have been eligible for screening under established criteria, such as from the USPSTF, ACS, and NCCN.

Among people diagnosed with lung cancer…

  • 65% would not have been eligible for lung screening under international guidelines. 
  • 44% had no smoking history. 
  • Screening eligibility differed sharply by sex, with men eligible at far higher rates than women (57% vs. 2.3%).
  • Smokers who weren’t eligible for screening had 5% lower rates of all-cause mortality and 4% lower lung cancer-specific mortality than smokers who were.
  • People who had never smoked had 14% lower rates of both all-cause and lung cancer-specific mortality. 

The data point out an interesting dilemma inherent in CT lung cancer screening, which from the outset was set up to be risk-based rather than population-based like mammography to avoid many of screening’s downsides, like overdiagnosis.

  • But that approach is missing many people who would otherwise benefit from screening, especially as we learn more about the elevated risk among many non-smoking populations, such as East Asian women.

The Takeaway

The new study shows momentum building toward broader CT lung cancer screening criteria that go beyond smoking status. The question is how quickly such criteria are adopted, and whether they gain traction outside of Asia, where recognition of lung cancer among non-smokers is growing.

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. 

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