Medical Societies Challenge Lung Cancer Screening Misinformation

Three leading medical societies have joined forces to combat what they describe as widespread misinformation about lung cancer screening, arguing that flawed research is deterring patients from potentially lifesaving tests.

In a joint statement published Tuesday in the Journal of the American College of Radiology, the American College of Radiology (ACR), American Society for Radiation Oncology (ASTRO), and Society of Thoracic Surgeons (STS) criticized recent scientific papers they claim overstate the risks associated with lung cancer screening.

“Propagating inaccurate test characteristics and overestimating rates of harm likely fuels unwarranted fear of overdiagnosis, overtreatment and iatrogenicity that deters patients from undergoing medically necessary testing and potentially lifesaving LCS,” the societies stated in their critique.

The medical organizations specifically highlighted a 2024 study published in the Annals of Internal Medicine, which reported high rates of downstream medical procedures and complications following lung cancer screening at five U.S. health systems. According to the societies, this study contained significant methodological flaws that led to misleading conclusions.

The physician groups noted that unlike the National Lung Screening Trial (NLST), which used structured medical record reviews, the criticized study relied on administrative data that is “often prone to misattribution.” They also pointed out that the study failed to provide clinical context for procedures and complications, making it impossible to determine whether these events were actually related to the screening itself.

Another major concern raised was the study’s attribution of complications for up to one year after baseline screening. The societies argue this approach artificially inflates complication rates by including unrelated medical events that occur months after the initial imaging.

“It is also important to emphasize that the harms of screening should largely be restricted to patients not ultimately diagnosed with lung cancer,” the joint statement explained. “Including procedural complications among patients with confirmed cancer misattributes known therapeutic risks to the screening test itself, a methodological flaw that has been well characterized in analyses of the NLST.”

False-positive reporting represents another area where misinformation has proliferated, according to the societies. They pointed to a 2023 consensus statement in the Journal of Thoracic Oncology that claimed the false-positive rate in the NLST was 96.4%. The societies clarified that this figure actually represents the false discovery rate—the proportion of positive screens that didn’t ultimately represent cancer—not the false-positive rate of lung cancer screening itself.

This mischaracterization creates a misleading impression that almost every lung cancer screening represents unnecessary testing. The societies noted that more than 40 peer-reviewed articles published in the last five years have incorrectly cited this figure, perpetuating the misinformation.

Lung cancer screening has been a point of emphasis for public health officials in recent years. The U.S. Preventive Services Task Force expanded its screening recommendations in 2021 to include adults aged 50-80 with a 20 pack-year smoking history who currently smoke or have quit within the past 15 years. Despite these recommendations, screening rates remain low, with less than 15% of eligible individuals receiving recommended screenings, according to the American Lung Association.

The societies acknowledged the importance of addressing legitimate concerns about lung cancer screening, including the need for high-quality care pathways and appropriate inclusion criteria. However, they emphasized that methodological issues in recent studies have led to an overestimation of potential harms.

“Clinicians and researchers should be mindful of these methodological pitfalls when interpreting LCS data,” the societies concluded. “We encourage journals and the medical community to perform similarly informed, diligent peer review.”