Tag: LDCT screening

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.

Two Views on Lung Screening’s Progress

Posted on by Brian Casey

Two new research studies published this week offer slightly conflicting views on the progress of CT lung cancer screening. One study saw the screening adherence rate rising to nearly 25%, while another revealed that screening might not be as effective in the real world as it was in the landmark National Lung Screening Trial. 

Low-dose CT lung cancer screening was approved for Medicare reimbursement in 2015 following promising NLST results, but the exam was slow to catch on.

  • That’s begun to change as U.S. physicians identify how to get eligible high-risk people into screening, while other countries are launching organized population-based screening programs, Germany being the most recent.

In the first study this week, published in JAMA Internal Medicine, researchers calculated the most recent uptake rate for LDCT lung cancer screening.

  • Data from 26.1k people from the BRFSS survey in 2024 were analyzed and compared to 2022 data.

The rate of up-to-date LDCT screening prevalence in 2024…

  • Rose six percentage points (24% vs. 18%).
  • Differed by just 0.5 percentage points between men and women.
  • Was highest and rose the most for people ages 65-69 (33%, increasing by 9 percentage points).
  • But still lagged screening rates for other cancers like breast (80%), cervical (75%), and colorectal (67%).

This week’s second study was published in JAMA Network Open and offers additional context, finding that real-world lung screening may not reduce all-cause mortality by as much as what was seen in the NLST.

  • Researchers analyzed screening’s effectiveness in a program run by the U.S. Veterans Health Administration, which has one of the more successful lung screening programs in the country.

They compared five-year all-cause mortality rates in the VA program for 732 people who were screened, finding that, compared to NLST…

  • Mortality rates were 2.5X higher in the VA population (24% vs. 9.7%).
  • VA participants had 3X the mortality risk (HR = 2.98).

VA researchers noted that while their population met the same screening eligibility criteria as NLST, the VA patients were sicker and probably less likely to see as much long-term benefit from LDCT screening.

The Takeaway

This week’s studies are a window into the complex changes underway in CT lung cancer screening. While screening’s rising participation rate is good news, the mortality findings show that estimating screening’s effectiveness is more complex than simply overlaying NLST results on real-world populations. 

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