Experts call for integration of breast and lung cancer screening programs

Experts are calling for greater integration of breast and lung cancer screening programs to help bolster monitoring for both diseases. 

Researchers with Thomas Jefferson University, Philadelphia, made the case in a new analysis published July 3 by the Journal of the American College of Radiology. They noted that, despite the proven lifesaving benefits of mammography, completion rates remain as low as 55%, with worse screening adherence among socioeconomically disadvantaged patient populations. 

Women eligible for lung cancer screening represent a unique population, they note, with elevated cancer risk and “substantial healthcare needs.” Previous studies have explored lung cancer screening among women already receiving mammography, but less is known about whether those actively engaged in LCS programs are up to date on their breast exams. 

“This represents an important gap in the literature because dual BCS/LCS-eligible women can be more efficiently identified from an [lung cancer screening] cohort than from a [breast cancer screening] cohort,” lead author Meghan Maceyko, MD, with the Department of Surgery at Thomas Jefferson, and colleagues wrote Friday. “Additionally, LCS participants may have access to highly structured LCS navigation pathways to facilitate BCS completion.”

The study focused on patients undergoing lung cancer screening within a centralized program at their academic medical center sometime between 2018 and 2025. Out of nearly 4,400 patients in this group, 2,100 were women also eligible for breast cancer screening. About 54% of the LCS group had completed screening mammography within one year of low-dose CT, the study found, and 67% within two years. These rates are lower than the national estimate approximating that almost 80% of women undergo screening mammography within two years, highlighting a “meaningful gap in screening completion among LCS participants.” 

Greater pack-years of smoking and personal history of cancer were significantly associated with being overdue for breast cancer screening, the study found. This suggests that patients at higher overall cancer risk “paradoxically” demonstrated lower BCS adherence, “underscoring a critical gap in preventive care delivery,” the authors contend. Black women also were significantly less likely to be overdue for BCS compared to white women. 

LCS participants with an electronic health record-documented diagnosis of chronic obstructive pulmonary disease were less often overdue on breast cancer screening. Meanwhile, those with self-reported COPD were more often overdue for BCS. EHR-documented COPD was significantly associated with lower odds of being behind on screening, the study found. 

“This may serve as a proxy for greater healthcare engagement, facilitating screening completion, whereas self-reported COPD may capture a more heterogenous population with lower health literacy or barriers to care,” Maceyko and colleagues wrote. “Although self-reported COPD was associated with a higher likelihood of being overdue for screening, this finding should be interpreted with caution given the modest absolute difference.”

Previous studies have demonstrated that breast cancer screening programs can feasibly identify individuals eligible for LCS, improving low-dose CT uptake. Maceyko and co-authors believe their study highlights a “reciprocal opportunity, potentially leading to an integrated screening framework in which participation in one cancer screening program facilitates engagement in others.”

“From a population health perspective, coordinated, multi-cancer screening strategies, such as embedding navigation and coordinated scheduling in LCS workflows, may amplify the impact of individual screening programs,” the authors noted. 

“Optimizing BCS within the LCS population may have the potential to reduce screening disparities and increase early breast cancer detection through a tailored approach for high-risk women,” they added later.