What Ails Lung Cancer Screening, with Douglas Wood, MD

The 2021 United States Preventive Services Task Force (USPSTF) guidelines define individuals aged 50-80 years old who smoked ≥1 pack of cigarettes daily for 20 years or who quit smoking within the last 15 years as high risk for lung cancer. These standards are even more inclusive than the prior USPSTF guidelines, which began defining patients as high risk at age 55, and with ≥30 pack years of cigarette smoking.1

Despite these widening parameters, as well as the fact that approximately 235,000 people were diagnosed with lung cancer in the US last year, national screening rates are dismal. The American Lung Association’s annual State of Lung Cancer Report estimated that only 16% of high-risk individuals were screened for lung cancer last year. In some states including Wyoming, the high-risk screening rate was 1 in every 12 individuals.2

Why? The answer is more complex than assumed.

In an interview with HCPLive at the American College of Chest Physicians (CHEST) 2025 Annual Meeting in Chicago, IL, Douglas Wood, MD, the Henry N. Harkins Professor and Chair of the Department of Surgery at University of Washington, discussed his presentation regarding the confluence of science and policy factors impacting poor US lung cancer screening rates.

The first factor touches on both science and policy: low dose computed tomography (CT) screening is a relatively new practice, and its coverage by insurers is recent.

“If we're just pragmatic, it does take time for the culture, policies, and procedures to get people to shift,” Wood said.

Unfortunately, the second factor is stigma — the kind that has prevailed in lung cancer for decades. This, coupled with the fact that patients with lung cancer generally come from a demographic that is poorly advocated for — many people of color, often from lower socioeconomic groups — results in a neglect where most other cancers have a robust awareness.

“[There is] an aspect of lung cancer that it is the fault of the individual, even though there's many individuals who get lung cancer that never had a smoking history,” Wood said. “The stigma associated with lung cancer is another problem with getting it to be accepted at the level that we have for breast or colon cancer screening.”

But the barrier that has frustrated Wood most in his career is the “nihilism in providers” — a generally negative disposition from primary care providers and pulmonologists regarding the benefit of detecting and treating lung cancer early at the expense of conducting screening.

This nihilism, Wood explained, is due to the invasive and potentially detrimental nature of CT scans.

“We have to recognize that when we do things like a CT scan on individuals that aren't ill, that we find other things that may result in some negative consequences,” Wood said.

That said, Wood acknowledge that the harms of CT scanning have been minimized through improved protocol for nodule management and observation versus immediate intervention. But the end result is a workforce of frontline clinicians and specialists who are reserving lung cancer screening for the highest risk individuals.

“It’s in balancing those [screening] harms against the harms of not screening people who might have lung cancer, that we're now at a stage where the balance is more that we should be screening more, instead of being very careful to not screen healthy individuals,” Wood said.

References

1. US Preventive Services Task Force, Krist AH, Davidson KW, et al. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(10):962-970. doi:10.1001/jama.2021.1117
2. American Lung Association. State of Lung Cancer. 2024. Accessed October 20, 2025. https://www.lung.org/research/state-of-lung-cancer