Imaging-related burdens may be keeping some from completing cancer screenings

A small but meaningful number of patients say low-dose CT lung cancer screening burdens are keeping them from completing their exams. 

The disease remains the leading cause of cancer death in the U.S., with early detection known to save lives. However, one recent analysis estimated screening adherence at 55%, with certain psychosocial, and financial factors impacting low-dose CT uptake. 

Researchers recently aimed to assess how the imaging exam itself might impact these numbers, sharing their finds in the Journal of the American College of Radiology. 

“Most research has focused on clinical outcomes, with less attention to how patients actually experience the screening test itself,” lead investigator Jessica H. Porembka, MD, with the UT Southwestern Medical Center, Dallas, said in a statement June 24. “We investigated whether patients experience short-term effects, such as discomfort or anxiety, related to lung cancer screening, particularly among underserved populations where barriers to care are greater.”

The prospective study was conducted between 2022 and 2024 at a university health system and safety-net hospital. It recruited both English- and Spanish-speaking patients scheduled for a low-dose CT scan within the next 15 days. Porembka and colleagues measured patient-reported testing burden using a previously proposed and validated measure. 

A total of 505 participants enrolled in the study, with 93% (or 468) completing their cancer screening and the related questionnaires. Average Testing Morbidities Index score was 97.5 at the university imaging site versus 96.1 at the safety-net hospital. (A 0 score on the scale indicates the worst possible experience, while 100 indicates the ideal one.)

Safety-net participants more often reported pain or discomfort before (13% vs. 6% at the academic site) and during their low-dose CT scan (16% vs. 8%). Further analysis showed that marital status, employment and insurance coverage were associated with greater testing-related morbidity, the authors reported. 

Porembka and colleagues believe their findings point to opportunities for targeted interventions aimed at reducing pre-test anxiety, improving the physical screening experience, and addressing structural barriers in underserved settings. 

“Lung cancer screening saves lives, but it only works if patients return year after year. Even small, temporary burdens from screening may influence whether people come back for annual exams—an essential component of screening effectiveness,” Porembka said in the announcement. 

Read more, including potential study limitations, in JACR. Those involved believe this is the first study to use a validated instrument to quantify the impact of lung cancer screening and examine how healthcare settings and social determinants influence the patient experience in medical imaging.