Oncology

Encouraging prevention in cancer care: Strategies to increase lung cancer screening rates

In more and more countries, people with an increased risk of lung cancer are eligible for screenings. However, many hesitate. Several factors are crucial in increasing the acceptance and participation rate of screenings. Discover five strategies that may help.

Benno Wagner

Published on March 7, 2025

Why screening matters

In the early stages, lung cancer often develops without symptoms. Once the tumor grows and affects neighboring tissue and organs, treatment becomes significantly more difficult. The Early Lung Cancer Action Program (I-ELCAP) proved in 1999 that early-stage tumors can be detected with a CT scan [1].
“The study showed that we could find 85% of the cancers in an early stage. Then you can really treat it, and the cure rates are very high,” emphasizes David Yankelevitz, MD, Professor of Radiology at Mount Sinai's Icahn School of Medicine.

Claudia Henschke, MD, in front of a Naeotom Alpha CT

Richard Booton: Portrait and quote

Mt Sinai Hospital New York, NY from outside

David Yankelewitz, MD, in front of a brick wall

Rimma Kondrashova portrait and qupte

Claudia Henschke, MD, in front of a Naeotom Alpha CT

However, screening rates are only slowly increasing. According to a US study, in 2022 only roughly 19 percent of people that are eligible actually get a scan [2]. "Why aren't people lining up around the block?", asks David Yankelevitz.

: Screening may take less time and effort for the patient than is often assumed, emphasizes Yankelevitz: “You get on the scanner. You take a breath in and then breathe out. The images are obtained. It's just getting on the table and sliding through the CT scanner very fast. Let's also emphasize that it's a low dose CT scan. It's the same as a mammogram that you get once a year.” Depending on the program, screenings are carried out at regular intervals, for example annually. If the CT scan shows a suspicious finding, doctors check the tissue with a biopsy and then decide on the treatment. “When it's small, the surgeon can take it out and you can be walking out of the hospital in a day or two. We've shown that radiotherapy also does very well. If you find it early, it’s a curable disease.”

Five strategies to increase screening rates

Despite national initiatives and technological advances, the acceptance of lung cancer screenings is still lower than for example for breast cancer screenings. Healthcare experts have identified five barriers to screening acceptance and share their strategies to increase participation.

1. Reaching communities

“Our challenge is to address the hard-to-reach population, which includes women, socially deprived people, and ethnic minorities,” explains Rimma Kondrashova, Radiologist at the Hannover Medical School in Germany. “We visit healthcare practices in areas with a high proportion of socially deprived people, we go to supermarkets or kiosks, providing clear information about the benefits of lung cancer screening.”

Richard Booton, MD, Professor of Respiratory Medicine at the University of Manchester, UK, deployed a mobile screening unit with examination rooms and a CT scanner in a truck to improve community outreach: “The mobile clinic was designed to be closer to home. We site them at football stadiums and supermarket car parks. Community-based screening is the right way, whether it’s done on the back of a mobile vehicle or in a fixed site in that community setting.”

2. De-stigmatize and demonstrate benefit

Lung cancer is still seen as a “death sentence” and smokers are “put themselves at risk.” These psychological barriers prevent many people from following a screening invitation. To increase acceptance, these prejudices must be dispelled. “There’s a lot of nihilism out there,” says Richard Booton. “But demonstrating benefit is also very powerful. Patients who got diagnosed with lung cancer are now going back to their local communities, interacting with family and friends. The power of positivity is important and persuading the population that lung cancer needs not be a guaranteed death sentence is part of it.”

Lung Screening: Patient and technician in conversation

3. Communicate comprehensively

Leaflets about lung cancer screenings, Mt Sinai Hospital, New York

For Rimma Kondrashova, the personal advice of trusted doctors is a crucial incentive for many at-risk patients to participate in screening. “It is important to coach the general practitioners and pneumologists who provide information about the screening to the patients.” In addition, Richard Booton calls for national awareness campaigns that places screenings in the overall context of lung health. “We have to make sure that we address the prevalence of tobacco smoking at the same time as implementing a lung cancer screening program. The two things go hand in hand.”

4. One-stop approach

A screening typically consists of a conversation for risk assessment and, if risk factors are present, a CT scan. Both should be combined into one appointment, recommends Richard Booton. “If you go through a risk assessment, and then you need to go for that CT scan on a separate occasion, there's about a 15% drop off rate. If we offer an immediate ultra-low dose CT scan, it's a one-stop visit and the translation from risk to scanning is very tight.” One pilot project in Estonia reached a participation rate of 79 percent by calling patients-at-risk and directly offered to schedule a CT-scan if they were smokers [3].

5. Increase capacities with AI

Collage of clinical images for lung screening

Reading CT scans is time-consuming. Artificial intelligence has the potential to significantly reduce the time required for each screening. For this purpose, Claudia Henschke and David Yankelevitz have initiated the AIRS project (Automated Image Reading System) [4]. Once an initial CT scan, which has been read by a radiologist, is available, AI can check at annual follow-up appointments whether the condition has changed or not. “The AI does a primary or rule-out read, where we identify those cases that the radiologist doesn't even have to look at.” This way, AI could help keep up with increasing screening numbers.

The success of screening programs always depends on how many patients accept the offer. In the words of Richard Booton: “Ultimately, screening is about getting bums on seats. It’s about getting as many people through as possible.” Strategies to reduce barriers and increase acceptance should be part of every sustainable and patient-centric screening program.

: The most important risk factors for lung cancer are considered age and tobacco use. Other factors are exposure to certain pollutants and genetic disposition [5]. Claudia Henschke has clear advice for anyone who suspects they are at risk: “Talk to your physician and tell them what your risk factors are. Then hopefully the physician will tell you to get a low dose CT scan. Make sure he or she recommends it. Make sure that you come back every year. It's important. The real life-saving benefit comes on the coming back every year.”

Podcast episode: A global perspective on lung screenings

Listen to Claudia Henschke, David Yankelevitz, Rimma Kondrashova and Richard Booton in conversation with Siemens Healthineers' clinical oncology consultant Victoria Schneider, on our podcast show, Healthcare Perspectives:

Portrait Benno Wagner

Portrait Benno Wagner

By Benno Wagner

Benno Wagner is a editor and multimedia content creator at Siemens Healthineers, specializing in patient care topics.

References

[1] https://www.ielcap.org/

[2] Henderson, L. M., Su, I.-H., Rivera, M. P., Pak, J., Chen, X., Reuland, D. S., & Lund, J. L. (2024). Prevalence of Lung Cancer Screening in the US, 2022. JAMA Network Open, 7(3), e243190-e243190. doi:10.1001/jamanetworkopen.2024.3190

[3] https://europeanlung.org/solace/2024/11/22/interview-with-tanel-laisaar-from-the-university-of-tartu/

[4] https://www.ielcap-airs.org/

[5] https://www.hopkinsmedicine.org/health/conditions-and-diseases/lung-cancer/lung-cancer-risk-factors

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