Obituary: "Wait until lung cancer causes symptoms, then scramble." It had a long run, mostly powered by bad odds and crossed fingers, and medicine should really stop sending it flowers.
That old approach is what lung cancer screening is trying to replace. The basic idea is almost suspiciously reasonable: if you look for lung cancer before it starts causing trouble, you have a much better shot at finding it early, when treatment can actually do something useful besides panic everyone in the room. The scan used here is a low-dose CT, which is basically a lower-radiation chest CT meant for people at high risk, especially because of smoking history.[1]
The JAMA Internal Medicine piece tied to this 10-year milestone has the exact energy the topic needs: yes, we have made progress, and no, we are absolutely not allowed to throw ourselves a victory parade just yet.[2]
The Good News Is Real
Screening works. That is not a vibes-based statement. Large trials showed that low-dose CT screening can cut lung cancer deaths by about 20% in high-risk groups, which is why it became a major recommendation in the first place.[3] The American Cancer Society updated its guidance in 2023, recommending yearly low-dose CT screening for people ages 50 to 80 with at least a 20 pack-year smoking history who currently smoke or used to smoke.[1]
And there has been movement. In a national 2024 analysis, about 24.5% of eligible adults were up to date on screening, which was a 6 percentage point jump from 2022.[4] That is not nothing. In public health terms, a 6-point jump is a decent step. In human terms, it means more people had a shot at catching a bad actor early, before it started redecorating the lungs like a tiny criminal with a crowbar.
The Bad News Is Also Real
Now for the less festive part: three-quarters of eligible people still were not up to date in 2024.[4] Another analysis found only 18% were up to date in 2022, with big differences from state to state.[5] So the story of lung cancer screening is not "medicine invented a life-saving tool and everyone sensibly used it." Obviously not. Humans never do anything that neatly. We are a species that knows vegetables are good and still buys gas-station nachos.
Why the gap? Some of it is logistics. Screening is not just one scan. First you have to know you qualify. Then a clinician has to bring it up. Then the imaging center has to exist somewhere near your actual zip code. Then insurance, scheduling, transportation, time off work, and follow-up all have to behave for once. A 2024 review in Chest found that programs do better when they use more than one tactic, like reminders, navigation, outreach, and clinician prompts, because the barriers show up in packs, like raccoons.[6]
Then there is stigma, which is a nasty little side quest in lung cancer. People who smoke or used to smoke often get hit with the moral subtext of "well, you brought this on yourself," which is both cruel and terrible public health. Add medical mistrust, rural access problems, and fragmented systems, and you get exactly what we have now: a test that saves lives, sitting there like a fire extinguisher behind glass while the building politely continues to smolder.[3,7]
Screening Is Not Magic, and That's Fine
It is also worth saying what screening is not. It is not a guarantee. Low-dose CT can find nodules that turn out to be nothing, which means false alarms, more scans, and a stretch of anxiety where your brain starts writing disaster scripts at 2:13 a.m. Overdiagnosis is also a real issue. Screening only makes sense when the people being screened are actually at high enough risk for the benefits to beat the downsides.[8]
That said, this is still one of the clearest cases in cancer prevention where earlier really is better. Lung cancer is often diagnosed late because it is sneaky. It does not stroll in wearing tap shoes. By the time symptoms appear, the disease may already have had time to spread. Screening is an attempt to catch it before the plot gets ugly.[1,3]
And there is one more twist. The eligibility rules themselves are still under debate. The American Cancer Society dropped the old "quit within 15 years" limit, arguing that many former smokers remain at meaningful risk long after that cutoff.[1] In other words, the guest list may still be too strict, and the bouncer may be turning away people who should be inside.
So yes, lung cancer screening has turned 10. It has achieved that very adult milestone of proving it works while also revealing how hard it is to get a good idea to behave in the real world. The science is ahead of the delivery system. Classic medicine, honestly. Invent the parachute, then spend a decade arguing about who gets a plane ticket.
References
- Smith RA, Fedewa SA, Sung H, et al. Screening for lung cancer: 2023 guideline update from the American Cancer Society. CA Cancer J Clin. 2024;74(1):50-81. DOI: https://doi.org/10.3322/caac.21811
- Brender TD, Richman IB, Gross CP. Lung Cancer Screening Turns 10-Progress and Plenty Left to Do. JAMA Intern Med. Published online April 27, 2026. DOI: https://doi.org/10.1001/jamainternmed.2026.0499
- Potter AL, Sequist LV, Yang CJ. Lung Cancer Screening Saves Lives, but Could Save So Many More. JAMA. 2025;334(24):2174-2175. DOI: https://doi.org/10.1001/jama.2025.23244
- Burus T, McAfee CR, Knight JR, Mullett TW, Hull PC. Lung Cancer Screening Prevalence and Changes in 2024. JAMA Intern Med. Published online April 27, 2026. DOI: https://doi.org/10.1001/jamainternmed.2026.0493
- Bandi P, Star J, Ashad-Bishop K, Kratzer T, Smith R, Jemal A. Lung Cancer Screening in the US, 2022. JAMA Intern Med. 2024;184(8):882-891. DOI: https://doi.org/10.1001/jamainternmed.2024.1655
- Núñez ER, Ito Fukunaga M, Stevens GA, et al. Review of Interventions That Improve Uptake of Lung Cancer Screening: A Cataloging of Strategies That Have Been Shown to Work (or Not). Chest. 2024;166(3):632-648. DOI: https://doi.org/10.1016/j.chest.2024.04.019; PMCID: https://pmc.ncbi.nlm.nih.gov/articles/PMC11904607/
- Kearney L, Nguyen T, Steiling K. Disparities across the continuum of lung cancer care: a review of recent literature. Curr Opin Pulm Med. 2024;30(4):359-367. DOI: https://doi.org/10.1097/MCP.0000000000001064
- Wikipedia contributors. Lung cancer screening. Wikipedia. https://en.wikipedia.org/wiki/Lung_cancer_screening
Disclaimer: The image accompanying this article is for illustrative purposes only and does not depict actual experimental results, data, or biological mechanisms.