December 1, 2025 – For decades, lung cancer has been associated with stigma, anxiety, and loss. Advances in screening, therapeutics, and survivorship have created a new reality; lung cancer is treatable, survivable, and increasingly understood as a chronic disease for many. A special issue of the Journal of the American College of Radiology , published by Elsevier and in collaboration with the American Cancer Society National Lung Cancer Roundtable (ACS NLCRT), details this transformation, outlining how radiology is moving beyond disease detection to providing equitable care and becoming a champion of patient dignity.
Cancer is the second leading cause of death in the United States and the leading cause of premature death as measured by years of life lost. Lung cancer is by far the most common cause of cancer deaths, responsible for the deaths of more people in the United States every year than the next two causes of cancer death combined among both men and women. In 2025, there were a projected 226,650 lung cancer cases diagnosed and 124,730 lung cancer deaths.
Transformation of the radiology landscape
A crosscutting theme reflected in this special issue is the move from counting scans to measuring impact across the full continuum of care.
"Lung cancer screening has matured into a system of care," explains Co-Guest Editor Lisa Carter-Bawa, PhD, MPH, Center for Discovery and Innovation at Hackensack Meridian Health, Nutley, NJ, and Georgetown Lombardi Comprehensive Cancer Center, Washington, DC. "It is not merely about increasing uptake; it is about ensuring that those who are screened are reached equitably, managed appropriately, and supported holistically. The next leap is ensuring every patient, in every setting, experiences screening as humane, coordinated, and equitable."
Contributors to the special issue identify the following four core principles defining the transformation of the lung cancer screening and treatment landscape:
- Radiology as an integrating hub: Screening is no longer a siloed service. Radiology is connecting prevention, tobacco treatment, diagnostic pathways, biomarker testing, and survivorship resources across systems to reduce fragmentation of care.
- Value over volume: Success is not just more LDCTs (Low-Dose CT scans), but equitable reach, appropriate follow-up, adherence, radiation stewardship, and minimizing harms.
- Human experience matters: Anxiety about scans and results, plus stigma tied to smoking history, can erode patient trust, reduce engagement, and affect long-term adherence. Programs that prioritize empathy, clarity, and respectful communication improve engagement.
- Refining whom we screen: Using epidemiological studies to refine the target population for lung cancer screening is critical to maintaining the balance of harms and benefits when screening high-risk individuals.
The special issue's articles detail the full scope of lung cancer screening, covering eligibility requirements (including the potential to leverage high mammography participation to engage women), strategies for increasing uptake through community-based interventions and state-level policy, a discussion of screening harms such as "scanxiety" as well as radiation dose management, and persistent implementation issues like system operability, challenges in rural cross-specialty collaboration, and cannabis use among screened individuals.
Maximizing impact and reframing the narrative
Co-Guest Editor Ashley Prosper, MD, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, notes, "Clinical trials and reports from real-world screening programs have confirmed that lung cancer screening is a worthwhile endeavor with the potential to significantly improve lung cancer outcomes. Maximizing this positive impact requires a combination of strategic multidisciplinary partnerships, effective communication, and informatics tools—closing data gaps between radiology, primary care, and oncology, which are foundational to timely diagnosis, appropriate follow-up, and equitable outcomes."
Co-Guest Editor Julie Barta, MD, Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, observes that "Although we know that lung cancer screening improves early detection and reduces lung cancer mortality, there is still much work to do in understanding how we identify high-risk patients for screening and deliver high-quality care."
The contributors emphasize that achieving this systemic transformation requires a unified effort to dismantle the historical stigma and fear associated with the disease and replace it with a message of hope.
"Lung cancer is treatable and survivable. Everyone and every patient deserve to know that. Radiologists and their teams are an integral part of the medical community and, together with our primary care clinicians and specialty colleagues, we can help to increase knowledge and awareness of what is possible and replace nihilism and stigma with empathy and hope for patients and their families," adds Ella A. Kazerooni, MD, MS, Chair, American Cancer Society National Lung Cancer Roundtable (ACS NLCRT), and Terry M. Silver Professor of Radiology and Professor of Internal Medicine, University of Michigan, Ann Arbor, MI.
"The question is no longer whether lung cancer screening saves lives—it does— but how we ensure that its benefits are realized broadly, equitably, and with dignity. Radiology is uniquely positioned to lead this charge," concludes Dr. Carter-Bawa.
