Lessons learned from pilot program integrating breast and lung cancer screening
Experts are sharing some key lessons learned from a pilot program that integrated both breast and lung cancer screening, seeking to boost adherence for the latter.
Lung cancer remains the leading cause of cancer death in the U.S., with fewer than 16% of eligible adults undergoing lifesaving low-dose CT surveillance. Conversely, breast cancer screening (BCS) reaches nearly 80% of eligible women, with many individuals dying of lung cancer despite attending routine mammography, experts write in JACR.
St. Louis-based Washington University’s School of Medicine has aimed to address this challenge. It’s “Pink and Pearl” pilot program has done so by leveraging strong BCS attendance to identify lung cancer screening (LCS)-eligible women during their routine mammography visit.
“Named for the breast (pink) and lung (pearl) cancer awareness ribbons, P&P uses established, trusted BCS visits as a ‘teachable moment’ for lung health discussions with women who may not otherwise be reached,” lead author Beryne Odeny, MD, MPH, PhD, an assistant professor of surgery at Washington University, and colleagues wrote Nov. 7. “Early studies demonstrate improved LCS uptake in eligible patients identified during BCS.”
WashU first launched the pilot in March 2025 at a breast imaging clinic and affiliated comprehensive cancer center in Missouri. The clinic provides BCS services to about 4,000 women each year, with its breast imaging director serving as clinical champion of the pilot, supported by the chiefs of breast and cardiothoracic imaging and the LCS program coordinator.
P&P follows a six-step coordination workflow tied to routine mammography. Stages include (1) assessing lung cancer screening eligibility via a questionnaire, (2) notifying the LCS nurse navigator, and also (3) looping in the patient’s primary care provider. This then leads to (4) the scheduling of a required shared decision-making visit and low-dose CT completion, (5) tracking of patient records by the nurse navigator, and (6) multidisciplinary team meetings. Those participating in the latter include radiology leadership, clinicians, mammography technologists, the LCS program coordinator and nurse navigator—who together assess the program’s quality and further refine workflows.
Out of 1,920 women ages 50 to 80 (the eligible LCS cutoffs), about 5% (or 102) reported any smoking history during their BCS visit. Of those, 93 women were potentially eligible based on the mammography tech’s screening. About 80% of them (or 74) accepted their referral to the LCS nurse navigator. Forty had never undergone lung cancer screening before, 28 had a prior LDCT, and six were deemed ineligible.
Between march and December 2025, 17% of these individuals had LCS orders placed and 15% completed screening. This represented about 35% of newly referred women. Of those, 13 had benign findings, and one had suspicious results that were currently under follow-up at the time of the study.
In assessing lessons learned from the pilot, Odeny and colleagues noted that most women were willing to discuss lung health at their mammography visit. Staff also found the new workflow “acceptable and feasible.” However, the 5% yield of women reporting a smoking history was below expected prevalence. Researchers attribute this, in part, to the face-to-face questionnaire administered by the technologist.
The largest losses occurred at referral (20% declined) and after PCP notification (60% without an order). Lags between primary care notification and LDCT order placement arose largely when women were identified outside their annual PCP visit, deferring shared decision-making discussions by up to one year.
“Strategies such as having a dedicated PCP or clinical champion and leveraging telehealth may fast-track [shared decision-making] and LDCT orders to close these gaps,” the authors noted. “Program metrics should track each cascade step including proportion with complete smoking history, LCS eligibility, prior LCS, referral of never-screened women, LCS completion, lung findings, and annual rescreening.”
Despite these challenges, WashU believes the pilot can be adopted elsewhere. Key elements should include a clinician champion, improved electronic health record documentation of smoking history, a confidential and standardized LCS questionnaire, and the dedicated nurse navigator/program coordinator.
“Several elements can be tailored to local context without compromising program fidelity, such as questionnaire format (in-person, paper, or electronic), educational material language and cultural framing, delivery setting (fixed clinic or mobile mammography unit), staff roles and task-sharing models, and EHR tool customization to local workflow,” the authors advised.
Read more, including potential study limitations, in the Journal of the American College of Radiology.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.