Addressing Misinformation in Lung Cancer Screening: Clinician Perspectives and Communication Strategies

A new retrospective cohort study offers a revealing look at the practical realities of lung cancer screening (LCS) in the United States, suggesting that the downstream risks associated with screening may be more significant in routine care than previously understood from clinical trials.

Using data from five U.S. healthcare systems, researchers followed 9,266 individuals who underwent baseline low-dose computed tomography (LDCT) scans for lung cancer screening between 2014 and 2018. While the mortality benefits of LDCT are well established—especially following the National Lung Screening Trial (NLST)—the real-world application of this approach appears to bring with it a higher burden of subsequent procedures and complications.

In this cohort, approximately 16% of patients had an abnormal result on their initial LDCT. Of those, 9.5% were ultimately diagnosed with lung cancer within a year. That figure reflects a positive predictive value (PPV) of 9.5%, with a negative predictive value (NPV) of 99.8%. Sensitivity and specificity were 92.7% and 84.4%, respectively, placing the diagnostic performance in line with previous trials—but what followed those abnormal results tells a different story.

Downstream imaging was pursued in nearly a third of all screened patients (31.9%), and 2.8% underwent invasive diagnostic procedures. While those rates might seem modest at first glance, the complication rates among patients who did require invasive procedures were significantly higher than what was seen in the NLST. In this real-world sample, 30.6% of patients experienced some form of complication, and 20.6% endured major complications—nearly doubling the corresponding figures from the NLST, which reported 17.7% for any complication and 9.4% for major ones.

This contrast raises important concerns about the consistency and safety of lung cancer screening practices outside the controlled environment of a clinical trial. Unlike the NLST, which applied rigorous protocols and specialist oversight, real-world settings may involve more variability in diagnostic decision-making, procedural expertise, and follow-up care. These differences likely contribute to the elevated complication rates and highlight an urgent need for improved risk stratification and clinical pathways once an abnormal scan is identified.

The study’s retrospective design, based on procedural coding, is a notable limitation—particularly when evaluating complications, which may be under- or over-represented depending on coding accuracy. Still, the scale of the dataset and the consistency of the findings suggest that these concerns are more than anecdotal.

For clinicians, these findings serve as a cautionary signal. While LDCT remains a powerful tool for reducing lung cancer mortality, its implementation must be matched by thoughtful, evidence-based downstream care to mitigate avoidable harms. The delicate balance between early detection and over-intervention continues to define the lung cancer screening landscape, and this study reinforces the need for systems-level improvements to protect patients as screening becomes more widespread.

Key Takeaways:

• Clinician groups are publicly rebutting claims that CT screening’s harms outweigh benefits to protect program participation and ensure appropriate referrals.
• Recommended tactics include risk‑stratified outreach, clear communication of absolute benefits and harms, and concise clinician toolkits.
• Coordinated society statements and patient‑facing education can counter misinformation and help maintain evidence‑based screening enrollment.