Barriers to Lung Cancer Screening Implementation in the US: Raymond Osarogiagbon, MD

In this clip, Raymond Osarogiagbon, MD, director of the multidisciplinary thoracic oncology program at Baptist Cancer Center, reviews the current US lung cancer screening guidelines and discusses their implementation, or lack thereof, across the country. He also outlines key barriers contributing to persistently low screening rates.

Osarogiagbon explored these issues further during his presentation, "How Far Are We From Successful Implementation of Lung Cancer in the US?" at the American Association for Cancer Research Annual Meeting 2025.

This transcript has been lightly edited; captions were auto-generated.

Transcript

Can you summarize the current lung cancer screening guidelines in the US?

The lung cancer screening guidelines are based on the US Preventive Services Task Force updated guidelines of 2021. Essentially, they identify patients who are between the ages of 50 and 80 years who either actively smoke, or, if they quit, did so less than 15 years ago, and who smoked the equivalent of 20 pack years.

A pack year is the equivalent of smoking 1 pack of cigarettes for 20 years, half a pack of cigarettes for 40 years, or 2 packs of cigarettes for 10 years.

As discussed in your presentation, how successful has the implementation of lung cancer screening been nationwide?

The implementation of lung cancer screening nationwide still leaves us a lot of work to do. We are excited, lung cancer screening saves lives; there's no doubt about it.

Now, the challenge is, can we make it happen everywhere? Our best estimate is that it's anywhere from 5% to 20% of eligible people who have had a screening test. If we want to be generous, we think maybe 1 in 5 people who qualify for screening have had a screening test.

What are the primary barriers contributing to the persistently low lung cancer screening rates across the US?

The reason why lung cancer screening rates remain persistently low is probably manifold. If we want to understand it better, we could categorize the reasons according to social policy, institutional barriers, clinician barriers, and patient-level barriers.

For example, policy level. The fact is that our lung cancer screening eligibility criteria, where we set the eligibility, actually disqualify more than half of the patients who wind up getting lung cancer, so less than half of the people who get lung cancer actually qualify for screening tests. So, that's one entirely different challenge. The other, of course, is that even among the people who do qualify for lung cancer screening, not everybody is insured. You gotta have access to health care coverage to be able to get a screening test.

Now, if we get past the policy level and we come to the institution level, lung cancer screening requires a CT scan once a year, but before you can do the CT scan, it requires a few hoops patients have to jump through. Not only do you have to make sure they qualify, you also have to do something called a shared decision-making process, where the patients are explained the risks and benefits of screening, and then they get a chance to say yes, if that's what they want, before they can actually go get the test.

A little bit of elaborate hoop jumping, and that makes it a little complicated for institutions. First of all, they have to have a CT scanner. Then, they have to have the whole process to be able to identify people. One of the things that we also are required to do is, for those who are still smoking, there needs to be a process of counseling them to get them to quit smoking, so you can imagine all this complexity makes it a little tougher for institutions to reliably establish screening programs.

If you look at the places where lung cancer screening programs have already been best established, they actually are mismatched with the places where lung cancer likes to kill people. Especially in the southern part of the United States, where we have the highest per capita density of patients with lung cancer, we also have the lowest density of accredited lung cancer screening programs, so that's at the institutional level.

Then, at the provider level, you have the challenge that most primary care doctors don't know what the rules are about lung cancer screening. In fact, most of them don't even know that lung cancer screening exists, that it saves lives. One of the barriers that we have is that people are not necessarily incentivized, clinicians are not necessarily incentivized to offer screening to people, primarily because they don't have a benchmark measure that makes them do it.

One of the things that we're working very hard to do is to develop something called a HEDIS [Healthcare Effectiveness Data and Information Set] measure that would incentivize programs and primary care providers to offer screening to patients who are eligible.