Lung cancer is the leading cause of cancer deaths among adults in the United States. More people die from lung cancer than from colon, breast and prostate cancer combined, according to the latest statistics from the American Cancer Society (ACS). The ACS estimates that 226,650 new cases of lung cancer will be diagnosed in 2025 and 124,730 will die from the disease.
Yet for those at elevated lung cancer risk, only about 18% receive a simple screening test recommended by the U.S. Preventative Services Task Force (USPSTF), the independent panel of experts that makes evidence-based recommendations to improve health. Making it even more perplexing is that these lifesaving scans are quick, painless and usually covered by insurance.
“It is so important to know about lung cancer screening,” says Dr. Loretta Erhunmwunsee, M.D., associate professor in the Division of Thoracic Surgery, Department of Surgery, at City of Hope® Cancer Center Duarte.
“It saves more lives than mammography or colonoscopy,” she tells City of Hope’s City Stories blog.
Lack of awareness as well as health care disparities contribute to the low screening rates, experts contend.
“There is a need to improve disease awareness and cancer literacy and to clearly define the role of primary care physicians in lung cancer care,” concludes a recent international study on the causes of low lung cancer screening rates globally published in Frontiers in Public Health.
In this article we will discuss:
- What Are Lung Cancer Screenings?
- What to Expect from a Lung Cancer Scan
- What Do the Statistics Show About Socioeconomic and Racial Disparities?
- Global Low-Dose Lung Cancer Screening Rates Also Low
- Why Aren’t Eligible Patients Getting Screened for Lung Cancer?
If you or a loved one has been diagnosed with cancer and are looking for a second opinion, call us 24/7 at 877-524-4673.
What Are Lung Cancer Screenings?
The USPSTF issued its initial recommendations on who is at an elevated risk for developing lung cancer and should receive lung cancer screening tests in 2013 and updated them in 2021. Those recommendations advise individuals aged 50- to 80-years-old, who have a history of 20 or more pack-years of smoking, are currently smoking or who quit less than 15 years ago to receive a low-dose computed tomography (LDCT) scan annually to screen for warning signs of lung cancer.
A pack-year is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years smoked. So, a person who smoked two packs a day for one year, would have two pack-years. If someone smoked one pack a day for 20 years, that would equal 20 pack-years.
“Most insurance companies and Medicare and Medicaid…will pay for [LDCT scans] because it's been approved by the Task Force and there has been shown to be a benefit,” says Maurie Markman, M.D., president of Medicine and Science, City of Hope Cancer Centers Atlanta, Chicago and Phoenix, in a January 2025 Medscape commentary, underlining the importance of screening.
Studies have shown that for those at high risk, LDCT scans may discover lung cancer at an early stage up to 85% of the time and reduce mortality by 20%. Generally, if lung cancer is caught early, survival rates may exceed 90%, according to the ACS.
Because lung cancer symptoms usually don’t appear until the disease has advanced, screenings are one of the only ways to ensure early diagnosis. Since the majority of lung cancer cases — about 4 out of 5 — are diagnosed in smokers, the screenings are crucial for this group. Environmental, lifestyle and genetic factors may also play a role in elevating lung cancer risk among non-smokers, but these individuals are not currently included in the regular screening recommendations.
While LDCT is the gold standard lung cancer screening test, scientists also have developed blood tests that may detect biomarkers that indicate disease presence or heightened risk.
Thoracic surgeon Dan J. Raz, M.D, M.A.S., associate professor in the Division of Thoracic Surgery, Department of Surgery, and co-director of the Lung Cancer and Thoracic Oncology Program at City of Hope, has been working with DELFI Diagnostics Inc. to try out a screening blood test for lung cancer. The test targets high-risk populations like long-term smokers as well as those who may not have access to health care or are exposed to harmful environmental factors like asbestos, radon or secondhand smoke.
Dr. Raz says such low-cost, simple screening methods like the blood test have the potential to save thousands of lives annually.
What to Expect from a Lung Cancer Screening Scan
Typical concerns patients may have about an LDCT lung cancer screening scan include:
- The amount of radiation they will receive during the process
- How often they will need to be screened
- Whether the process will make them feel uncomfortable or claustrophobic
- Experiencing anxiety while waiting for results
- Follow up tests that may be necessary
Too much radiation may be harmful, so health care professionals are careful about the amount of radiation exposure for their patients. An LDCT exposes a patient to slightly more radiation than a typical mammogram or chest X-ray, but only one-fifth the radiation from a regular CT scan.
Since the LDCT is a screening test to detect broad abnormalities or changes in the tissue, not fine details, this lower radiation option is used. And since the scan is looking at lung tissue, not dense bone, less radiation is needed to get the necessary information.
“We only need to see things in the lungs, and therefore, we can decrease the dose that we’re delivering,” says Jason Beland, M.D., chair of the Department of Radiology with City of Hope Atlanta, Chicago and Phoenix. He adds that for those at high risk for developing lung cancer the value of screening far outweighs the minimal risks of radiation.
Receiving an LDCT scan is painless, quick and performed in an outpatient setting at a hospital or clinic. No special diet or preparation is needed beforehand. Just remember to leave any jewelry at home since you will not be able to wear anything metallic while undergoing the scan.
You will likely be asked to remove your clothing from the waist up and wear a hospital gown as you lie flat on the scanner table.
Dr. Beland reassures patients about claustrophobia for this test.
“If we think of an MRI machine as a tube, a CT scan would be a donut,” he says. “Your whole body is not all the way into the machine as it is for an MRI.”
The technician may move the table with you lying on it in and out of the scanner to calibrate the machine to your unique body. When it is time to perform the actual scan, you will hold your breath for about 5 to 10 seconds to keep your lungs still and allow clearer scanned images.
“One of the common concerns of screening is the anxiety of waiting for the results and getting an abnormal result,” Dr. Beland says, reminding patients that the exam won’t tell you whether you have cancer, only if there are abnormalities in the lungs that require further investigation.
If the doctor sees something suspicious on the LDCT scan, a follow-up scan, perhaps a higher resolution CT scan or a biopsy may be recommended. Again, the abnormality may be a benign nodule, and not cancer. A follow-up test can provide that information.
“Small lung nodules are very common, particularly in smokers,” Dr. Beland says. “It’s not uncommon to find things.”
But while 15% of lung cancer screening tests find a nodule, 90% will be benign and not require treatment, Dr. Beland says.
The recommendation for those eligible is to have an LDCT screening scan annually. This helps identify any changes in the lungs over time. In certain cases, more frequent follow-up scans may be recommended. Once you have gone 15 years without smoking, you may stop getting yearly screening if past test results have been negative.
What Do the Statistics Show About Socioeconomic and Racial Disparities?
While the chances of developing lung cancer for the overall population — smokers and nonsmokers — is about 1 in 17 for men and 1 in 18 for women, according to the ACS, the risk rises significantly for smokers. Racial disparities also are striking.
For instance, according to the ACS, Black men are about 12% more likely to get lung cancer overall than white men.
Part of the disparity may be because Black smokers have lower rates of lung cancer screening than white smokers, according to a 2019 study published in the Annals of the American Thoracic Society. The researchers concluded: “Revisions to screening guidelines should consider racial/ethnic variation in cigarette smoking, additional risk factors and overall level of risk.”
Dr. Erhunmwunsee is particularly interested in the impact of socioeconomic and racial factors on lung cancer risk. Her research has confirmed that low socioeconomic status is associated with poor outcomes and worse quality of life among those diagnosed with lung cancer. She continues to explore the environmental and health care access issues that may contribute to these socioeconomic and racial differences in lung cancer prevention, diagnosis and outcomes.
Barriers to getting screened may come down to very practical matters.
“There are now a lot of facilities that have low-dose CT scans, but for the underserved population, it may be difficult to get access,” says Peter Baik, D.O., F.A.C.O.S., F.A.C.S., a thoracic surgeon at City of Hope Cancer Center Phoenix — a metropolitan area where screening rates are particularly low. “For example, what if they work during the day? How many imaging centers offer low-dose CT after hours? They may have transportation issues, or maybe they don’t have a primary care physician or resources to be screened or counseled about lung cancer.”
Global Low-Dose Lung Cancer Screening Rates Also Low
Beyond the United States, other countries in Asia, Europe and North America have similarly low screening rates, according to research.
The 2023 Frontiers in Public Health study examined what may be contributing to such low rates in 10 countries and concluded that, depending on the country, prominent reasons include:
- Cost
- Lack of government support; not making it a government priority
- Not having the necessary health care infrastructure
- Lacking awareness of the screening’s benefits
- Cultural stigmas around smoking and lung cancer
The American Lung Association concluded in its 2024 report on lung cancer in the United States: “Every state can do more to defeat lung cancer, such as increasing the rate of screening among those at high risk, addressing racial disparities that impact lung cancer outcomes, decreasing exposure to radon and secondhand smoke and eliminating tobacco use.”
Why Aren’t Eligible Patients Getting Screened for Lung Cancer?
While it’s widely agreed that screening for lung cancer is a valuable tool in preventing and improving outcomes, the benefits of LDCT lung cancer screening have not reached the level of general public awareness of screening tests like mammograms or colonoscopies, experts say.
Unlike the widely known recommendations for those common screening tests, which include large swaths of the general public, eligibility for the lung cancer screening is more complicated. Lung cancer screening recommendations are not just based on age, but also smoking history, calculated in pack-years. Admitting to long-term smoking may be a barrier for some patients in talking with their health care team.
Uncertainty about insurance coverage — most private insurance, Medicaid and Medicare do cover lung cancer screening — and easy access to facilities providing the screening scans are also considerations. Educating primary care physicians to identify patients eligible for the scans and helping to ensure they follow through and receive the tests annually also may help turn the tide for those who can most benefit from this crucial cancer screening.
If you or a loved one has been diagnosed with cancer and are looking for a second opinion, call us 24/7 at 877-524-4673.