Many medical organizations have been recommending lung cancer screening for decades for those at high risk of developing the disease.

But in 2022, less than 6% of people in the U.S. eligible for screening actually got screened. Compared with other common cancer screenings, lung cancer screening rates fall terribly behind. For comparison, the screening rate in 2021 for colon cancer was 72%, and the rate for breast cancer was 76%. Why are lung cancer screening rates so poor?

I am a pulmonologist who specializes in screening and diagnosing lung cancer. In my research to improve early detection of lung cancer, I’ve found that numerous complex barriers hinder the widespread adoption of lung cancer screening.

Lung cancer is the leading cause of cancer-related death in the world. But early detection can significantly improve outcomes.

Survival rates for early stage lung cancer are nearly seven times higher than lung cancer that has spread in the body. Between 2015 and 2019, survival rates for lung cancer have improved by 22%, in part because of an increase in earlier diagnosis.

Most patients with early-stage lung cancer, however, have no symptoms and aren’t diagnosed until they reach more advanced stages that are harder to treat, underlining the need for effective lung cancer screening.

The U.S. Preventive Services Task Force recommends lung cancer screening for people 50-80 years old, people who currently smoke or previously smoked but quit within the past 15 years, and people who smoked at least 20 pack-years. Pack-years is an estimate of cigarette exposure in a person’s lifetime, calculated by multiplying the total number of years someone has smoked by the average number of packs smoked per day. For example, if someone smoked half a pack per day for 40 years, they would have smoked for 20 pack-years.

One of the primary barriers to lung cancer screening is lack of public awareness and understanding. Many people are unaware they qualify for lung cancer screening or have misconceptions around what to expect from the screening process.

Lung cancer screening involves a yearly low-dose computed tomography, or CT, scan, a diagnostic imaging tool that uses X-rays to create detailed cross sections of the inside of the body. Screening 250 patients can prevent one lung cancer death. In comparison, 645 people screened with a mammogram can prevent one breast cancer death.

Some people have reservations surrounding the scan itself because of radiation exposure. The radiation from a low-dose CT scan, however, is about 1.4 millisieverts – the scientific unit used to measure ionizing radiation – which is less than the 3 to 5 millisieverts of background radiation a person may be exposed to in a given year on average while living on Earth.

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