Bettering CT Scan Rates in Pulmonology, with Graham Barr, MD, DrPH

Despite there being highly determinable clinical and behavioral risk factors, access to Medicare-covered screening measures, and a severe mortality risk in cases diagnosed too late, the frequency of lung cancer screening remains precipitously low among eligible patients in the US.

The matter of improving this recurring trend — as has been previously discussed by experts — requires behavioral shifts from clinicians in the position to seek out a diagnosis.

In an interview with HCPLive during the 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) International COPD Conference in Philadelphia, PA, Graham Barr, MD, DrPH, Chief of the Division of General Medicine at NewYork-Presbyterian and Columbia University Irving Medical Center, discussed the continually minimal use of low dose computed tomography (CT) scans on patients at determined risk of lung cancer.

As Barr emphasized, low dose CT scan is not some novel, unevidenced diagnostic tool — is it covered by Medicare and private insurers and is recommended for use in eligible patients based on criteria factors by the United States Preventive Services Task Force (USPSTF). Despite it being available and endorse like any standard screening tool, only about one-fourth (28.1%) of US patients are diagnosed at an early lung cancer state during which they experience a 65% five-year survival rate. US patients are primarily diagnosed (43%) in late-stage lung cancer, when survival rate is approximately 10%.

From Barr’s perspective, the common reasons why a colleague may not prescribe a primary cancer test do not apply to low dose CT scans: it is neither costly like a full pulmonary function test, nor is it linked to a high risk of adverse events like initially believed.

“It's a dramatically underused test and it's sort of staggering that we're still in this position,” Barr said. “It would not be acceptable if we were talking about breast cancer screening, if we were talking about pap smear screening, and so forth. We have to straighten this out.”

Barr disagreed with the theory that patient follow-through on screening referrals have a major impact on the utility of low dose CT scans. Instead, he said systems have been slow to adopt it as standard practice and clinicians are still struggling with the stigma tied with smoking.

“We still have a habit of saying, ‘Somebody got into this trouble by smoking’,” Barr said. “But whether or not they have quit [the habit], they’re still eligible [for screening] in the most part, and we should be pushing it aggressively.”

As Barr looks at the checklist of hurdles his colleagues must still clear to streamline low dose CT scans in pulmonology practices, he highlights “evidence.” There are mortality reduction-based data supporting the tool but even more robust randomized clinical trial data showing the benefit of timely lung cancer screening in the continuum of care for eligible patients. Healthcare systems can play their role by implementing quality control programs to assess their own outcomes and refine their internal processes to both clinician and patient satisfaction.

More supporting data, and a system tailored to their practice and patients, may help to overcome the stigmas surrounding both lung cancer and low dose CT scans.

“There’s not an inherent resistance to mammography screening, colon cancer screening…there’s really no reason we shouldn’t get this done,” Barr said.

References

1. Wood D, Kunzmann K. What Ails Lung Cancer Screening, with Douglas Wood, MD. HCPLive. Published October 20, 2025. https://www.hcplive.com/view/what-ails-lung-cancer-screening-douglas-wood-md
2. American Lung Association. State of Lung Cancer 2025: Lung Cancer Key Findings. Web page. Last updated November 3, 2025. https://www.lung.org/research/state-of-lung-cancer/key-findings