Key takeaways:

• 15% of eligible U.S. adults reported discussing lung cancer screening with a health care professional in the past year.
• Communication varied based on race, insurance status, smoking history or comorbidities.

Only about one in six U.S. adults eligible for lung cancer screening discussed the procedure with a health care professional in the past year, according to study results.

Current smokers and those with comorbidities more often reported having those discussions, a finding researchers say suggests clinicians prioritize individuals most at risk.

Data derived from Viana SW, et al. Am J Surg. 2026;doi:10.1016/j.amjsurg.2026.117131.

However, an analysis of Health Information National Trends Survey (HINTS) data revealed what investigators called “persistent gaps” in communication that appeared more pronounced based on individuals’ race, insurance status and social context.

“We know lung cancer screening is not well utilized compared with screening for other cancer types, so we expected conversations about this topic would be infrequent. However, it was surprising to see such a low rate,” lead author Sofia W. Viana, MD, research fellow in the department of thoracic surgery at University of Cincinnati, told Healio.

The findings highlight the need for targeted interventions designed to overcome structural barriers, improve clinician-patient communication and leverage social networks to increase awareness — and ultimately uptake — of lung cancer screening, Viana added.

‘Slowly improving’

Lung cancer is the leading cause of cancer death in the United States.

The U.S. Preventive Services Task Force (USPSTF) has recommended lung cancer screening with low-dose CT for high-risk individuals since 2013 based on results of the National Lung Screening Trial, which showed screening with low-dose CT reduced lung cancer-specific mortality by approximately 20% compared with standard chest X-rays.

The USPSTF guidance — last updated in 2021 — recommends annual screening for individuals aged 50 to 80 years who have a 20 pack-year smoking history and either currently smoke or quit within the prior 15 years.

Despite this guidance, lung cancer screening remains underutilized. Only about 20% of eligible individuals in the U.S. adhere to screening recommendations, according to study background.

“It is slowly improving, which is good, but it’s still very, very low when you compare it to other screening rates like colonoscopy or mammograms, [which] are usually in the 70% to 80% range of people getting screened,” senior author Robert M. Van Haren, MD, associate professor of clinical surgery at University of Cincinnati College of Medicine, said in a press release.

Prior research has identified several barriers. These include patient-level factors — such as limited awareness of screening availability and its potential benefits — and clinician- or system-level factors, such as insufficient time during clinic visits to discuss screening, uncertainty about eligibility criteria, and lack of medical record data or automated electronic health record notifications that could help identify eligible individuals.

However, the frequency with which clinicians and patients discuss lung cancer screening with low-dose CT on a population level had not been established.

Viana, Van Haren and colleagues aimed to quantify that prevalence, as well as identify demographic, psychosocial, clinical or health system factors associated with these discussions among adults at risk for lung cancer.

The researchers used data from HINTS 7 to answer those questions. NCI conducted the nationally representative survey in 2024 to assess U.S. adults’ knowledge of, attitudes toward and use of information related to cancer and other health topics, as well as their communication with health care professionals.

“We know how important patient-clinician communication is, as well as how a person’s trust in their physician influences their decisions,” Viana said. “The HINTS platform allowed us to examine if communication between clinicians and patients may be a barrier that influences lung cancer screening rates in the U.S.”

‘Concerning’ findings

The analysis included 1,506 survey respondents (mean age, 63 years; 57.4% men; 76.6% non-Hispanic white) who met eligibility criteria, nearly all (98.9%) of whom reported smoking more than 100 cigarettes in their lifetime.

Overall, 221 respondents (15%) reported that they had discussed lung cancer screening with low-dose CT with a health care professional in the prior year.

Multivariable analysis identified several factors associated with discussion prevalence.

Odds for these conversations appeared significantly higher among those who identified as current smokers (adjusted OR = 6.37; 95% CI, 3.82-10.64) and those with lung disease (aOR = 3.04; 95% CI, 1.72-5.39).

These findings suggest clinicians appropriately prioritize screening discussions among individuals they consider at greatest risk, according to researchers.

Asian individuals (aOR = 0.14; 95% CI, 0.03-0.65) and Hispanic individuals (aOR = 0.3; 95% CI, 0.16-0.89) appeared less likely to have screening discussions than non-Hispanic white individuals. This is “particularly concerning” due to documented differences between racial and ethnic groups with regard to lung cancer stage at diagnosis and outcomes, investigators wrote.

Odds of screening discussions appeared significantly lower among those who lacked health insurance coverage (aOR = 0.2; 95% CI, 0.05-0.6), but significantly higher among those who indicated they had trust in family members for cancer-related information (aOR = 3.92; 95% CI, 1.8-8.53).

Univariate analysis showed greater likelihood of screening discussions among survey respondents who had a heart condition (31.3% vs. 16%; P = .005) or depression (41.3% vs. 29.2%; P = .033), those who reported some college education (43.9% vs. 32.8%; P = .008), and those who reported having trust in their clinician (99.4% vs. 96.8%; P = .007).

Lung cancer screening discussion prevalence did not vary by other self-reported healthcare experiences, including survey respondents’ feelings about whether they regularly have enough time with their healthcare professional or their trust in the healthcare system.

‘Multifactorial’ problem

The investigators acknowledged study limitations.

Use of self-reported survey data creates the potential for recall bias or misclassification, and the cross-sectional nature of the dataset precludes proving causality between patient characteristics and frequency of screening discussions.

HINTS data uses broad classification of clinician-patient communication and does not distinguish physicians from advanced practice providers or other clinicians who may have been involved in screening discussions. Also, limited racial and ethnic diversity in the cohort requires careful interpretation of data, according to researchers — particularly with regard to data about respondents’ trust in healthcare professionals.

Overall, however, the findings suggest clinician-patient discussions about lung cancer screening remain “markedly underutilized” despite evidence supporting its potential to reduce lung cancer mortality among high-risk individuals, Viana and colleagues concluded.

Clinician education and dissemination of guidelines for lung cancer screening — which is relatively new — is an essential first step, according to investigators. Improved smoking history documentation in the EHR, as well as incorporation of automated prompts that identify screening-eligible individuals, also could help.

“In a way, breast cancer screening is better understood, because women at age 40 are recommended to undergo screening at specific intervals,” Viana said. “The same is true for colorectal cancer. Lung cancer screening criteria has multiple components — age, smoking status and pack-years — so the public and even their clinicians don’t always realize who needs it.”

Targeted interventions may be necessary to ensure broader adoption of evidenced-based screening, they added. These measures could address structural barriers, cultural beliefs or language barriers that could contribute to inequities across individuals of different races or ethnicities.

The fact that survey respondents who expressed greater trust in family members for cancer-related information appeared significantly more likely to report screening discussions highlights the potential to leverage social networks to encourage engagement with preventive health services, researchers added. They noted this effort could be particularly impactful for high-risk populations that historically have limited access to preventive care or may have lower levels of trust in the healthcare system.

“This is a multifactorial problem,” Viana said. “We cannot simply say the problem is with patients, with physicians or with the healthcare system. We need to address all areas if we want to see improvement.”

Viana and colleagues are continuing their research in this area by interviewing primary care physicians and patients to learn more about the barriers that may prevent conversations about lung cancer screening from taking place.

They hypothesize that the fact lung cancer screening is relatively new — compared with modalities used to screen for other types of cancer — as well as the stigma and fear often associated with lung cancer may emerge as contributing factors.

For more information:

Sofia W. Viana, MD, can be reached at wagemasa@ucmail.uc.edu.