Lung cancer screening can detect tumors before symptoms appear, when treatment is more likely to succeed, yet a national analysis suggests that the conversation needed to reach eligible patients is still largely missing from routine medical care. Only 15% of American adults who meet screening criteria reported discussing lung cancer screening with a doctor, according to researchers at the University of Cincinnati Cancer Center. Although the figure represents a gradual improvement over previous data, it remains far below discussion and participation rates associated with other major cancer screenings. Researchers say the findings highlight a persistent public-health gap: a potentially life-saving test exists, but many people who could benefit from it may not know they qualify or may never be offered the opportunity to consider it.
The study, published in The American Journal of Surgery, analyzed information from the latest version of the Health Information National Trends Survey, or HINTS. Conducted by the National Cancer Institute, HINTS is designed to provide a representative picture of health-related knowledge, behavior and communication across the United States. The survey asks participants about subjects including smoking, alcohol use, diet, exercise and preventive medical care, as well as whether they have discussed screenings for lung, breast and colorectal cancer with healthcare professionals. By examining these responses, the University of Cincinnati team sought to identify how frequently conversations about lung cancer screening occur and which factors may be associated with those discussions.
The central finding was striking because lung cancer screening is recommended for a clearly defined high-risk population, rather than for every adult. The U.S. Preventive Services Task Force recommends annual screening with low-dose computed tomography, commonly called low-dose CT, for adults ages 50 through 80 who have accumulated at least 20 pack-years of smoking and who currently smoke or quit within the past 15 years. A pack-year is a measure of cumulative tobacco exposure calculated by multiplying the number of cigarette packs smoked each day by the number of years a person smoked. Someone who smoked one pack daily for 20 years, or two packs daily for 10 years, would have a 20 pack-year history.
Low-dose CT screening uses an X-ray system to create detailed cross-sectional images of the lungs while exposing the patient to less radiation than a conventional diagnostic CT scan. During the examination, the patient lies on a table that moves through the scanner and briefly holds their breath while images are captured. Unlike many other medical procedures, the test generally requires no intravenous contrast, needles, anesthesia or special preparation. The scan is fast and noninvasive, allowing radiologists to examine lung tissue for small nodules and other abnormalities that may be invisible on a standard chest X-ray or undetectable through symptoms alone.
The technical advantage of screening is its ability to identify disease during a stage when a tumor may remain localized and more amenable to surgery, radiation or other curative treatment. Lung cancer often produces no warning signs until it has advanced, and symptoms such as persistent cough, chest pain, breathlessness or unexplained weight loss can appear only after the disease has spread or begun affecting lung function. Low-dose CT does not guarantee that every cancer will be found, and an abnormal result is not automatically a diagnosis of cancer. Small nodules are common and may reflect infections, scarring or other benign conditions, meaning that some patients require follow-up imaging or additional testing. Even so, screening is intended to shift detection earlier, when treatment options and outcomes are generally more favorable.
Robert Van Haren, MD, senior author of the analysis and an associate professor of clinical surgery at the University of Cincinnati College of Medicine, said the 15% discussion rate is improving but remains alarmingly low compared with other screening practices. Colonoscopy and mammography, he noted, commonly reach discussion or completion rates in the range of 70% to 80%, depending on the measure and population examined. The contrast suggests that the problem is not simply a lack of medical technology, but also a failure to consistently connect eligible patients with information about the technology. A patient cannot weigh the potential benefits and limitations of screening if the subject never enters the consultation room.
The need for greater awareness may be particularly urgent in the Greater Cincinnati region, where smoking remains substantially more common than in the United States overall. Nine of the 10 counties primarily served by the University of Cincinnati Cancer Center have smoking rates above the national average, according to the researchers. Approximately one in three adults in the region smokes, a proportion described by Van Haren as roughly twice the national rate. Higher tobacco exposure increases the number of people who may eventually meet screening criteria, while stigma surrounding smoking-related disease can make some patients reluctant to discuss their risk. Fear of a cancer diagnosis may also lead people to avoid screening, even though early detection is precisely the reason the test is recommended.
Researchers believe the relatively recent arrival of low-dose CT screening may be another barrier. While lung cancer has been screened and diagnosed for decades, modern low-dose CT programs became established within the past 15 years, and public awareness has not necessarily kept pace with the evidence. Patients may confuse screening with a routine chest X-ray, assume the test is invasive, or believe that the absence of symptoms means screening is unnecessary. Some may also be uncertain about whether former smokers remain eligible after quitting. Clear communication from primary care clinicians could help resolve these misunderstandings by explaining the eligibility criteria, the mechanics of the scan, the possibility of false-positive findings and the importance of annual follow-up when screening is recommended.
The University of Cincinnati team is now interviewing primary care doctors and community patients to investigate why these discussions are not occurring more often. Supported by a Cancer Center pilot grant, the project is examining practical and psychological factors that may influence screening conversations, including limited appointment time, uncertainty about guidelines, stigma, fear and the relatively new status of low-dose CT. Understanding whether the main obstacle lies with patients, clinicians, healthcare systems or a combination of all three could help researchers design more effective interventions. Possible solutions may include targeted education, electronic reminders, community outreach and partnerships that connect high-risk adults with screening programs.
Van Haren said the long-term goal is to build stronger community and regional partnerships and launch a focused awareness campaign that encourages eligible people to ask about screening while helping clinicians identify those who qualify. The researchers emphasize that screening is not intended for every adult and should be considered through shared decision-making with a healthcare professional. For people within the recommended age range who have a substantial smoking history and currently smoke or quit within the past 15 years, however, the first step may be as simple as starting a conversation. As lung cancer continues to claim lives after remaining undetected for too long, increasing those conversations could turn an underused preventive tool into an earlier warning system for thousands of Americans.
Subject of Research: Factors associated with patient-clinician discussions about low-dose CT screening for lung cancer.
Article Title: National analysis of factors associated with patient-clinician discussions about lung cancer screening
News Publication Date: 21-Jul-2026
Web References: https://www.sciencedirect.com/science/article/abs/pii/S0002961026003168; https://doi.org/10.1016/j.amjsurg.2026.117131
References: The American Journal of Surgery; Health Information National Trends Survey; U.S. Preventive Services Task Force lung cancer screening recommendations.
Keywords: Lung cancer, low-dose CT, lung cancer screening, smoking, pack-year history, cancer prevention, early detection, patient-clinician communication, public health, computed tomography
