Only 15% of eligible Americans discuss lung cancer screening with doctors

A screening test that can catch lung cancer before it becomes lethal sits largely unused. Only 15 percent of Americans who qualify for the procedure have ever mentioned it to their doctor, according to researchers at the University of Cincinnati Cancer Center who analyzed national health survey data. The finding, published recently in the American Journal of Surgery, reveals a striking gap between a tool that saves lives and the people it could help.

The test itself is straightforward. A patient lies down, holds their breath for a moment while a low-dose CT scanner—a gentler cousin of the standard CT machine—takes pictures of the lungs. No needles, no fasting, no preparation. It takes minutes. Robert Van Haren, an associate professor of clinical surgery at UC and senior author of the study, describes it as probably the easiest of the three major cancer screenings available to Americans. Yet when compared to colonoscopy and mammography, where 70 to 80 percent of eligible people participate, lung cancer screening looks abandoned. The 15 percent figure does represent slow improvement from previous years, but the gap remains enormous.

The researchers drew their data from the Health Information National Trends Survey, a project of the National Cancer Institute designed to capture a representative snapshot of American attitudes toward health, behavior, and communication with doctors. The survey asks about diet, exercise, smoking, alcohol use, and screening practices across the country. What emerges is a portrait of a nation largely unaware that this screening exists or that it might apply to them.

The need is acute in the region Van Haren and his colleagues serve. Nine of the ten counties in the Greater Cincinnati area report smoking rates above the national average. Roughly one in three adults in the region smokes—double the national rate. These are precisely the people most likely to benefit from screening: adults between 50 and 80 who have smoked at least one pack a day for twenty years, or who quit within the past fifteen years. In a region where smoking is this common, the absence of conversation between patients and doctors about screening represents a missed opportunity on a significant scale.

Van Haren and his team are now investigating why these conversations aren't happening. With funding from a Cancer Center pilot grant, they are interviewing primary care physicians and patients to map the barriers. Early thinking points to stigma—the lingering sense that lung cancer is a disease people bring on themselves—and fear. There is also the simple fact that low-dose CT screening is relatively new, arriving in its current form only in the last fifteen years. The message that it exists, that it works, and that it can detect cancer when treatment is most effective has not yet reached the people who need to hear it.

Van Haren's vision for the next phase is straightforward: more partnerships between researchers, community organizations, and healthcare systems, coupled with a sustained awareness campaign. The goal is to normalize the conversation between patient and doctor, to make screening something people ask about the way they ask about colonoscopies. He frames it not as a burden but as a choice—a way to catch cancer early, when doctors can treat it successfully. The research suggests that awareness and access are not the only barriers; something deeper, rooted in how Americans think about lung cancer and who deserves screening, is at work. Understanding that something, and changing it, is the work ahead.