Process perspectives on lung cancer screening in primary care: a qualitative study of providers and staff in an urban U.S. healthcare system.

Lung Cancer Screening in a Rural Academic Health System Reveals Low False-Positive Rates.

Lung cancer is the leading cause of cancer-related deaths worldwide and among Singaporean males. While incidence in Singapore has declined due to reductions in smoking, patient outcomes have also improved because of advances in our understanding of cancer biology, lung cancer screening, and refinements in treatment. In the Republic of Singapore Air Force, its first diagnosed case of aircrew lung cancer was presented and deliberated at its Aeromedical Board in October 2024. A narrative review was conducted to summarize aeromedically relevant updates on the current assessment and management of lung cancer, with a focus on return-to-flying considerations as well as future implications for military aircrew. Developments in immune checkpoint inhibitors and targeted therapies has driven the requirement for molecular and immunohistochemical diagnosis in lung cancer management. Together with advances in radiation therapy and minimally invasive surgery techniques, lung cancer screening and smoking cessation have significantly improved disease mortality and morbidity. Despite this, a safe return to aviation duties may remain limited by treatment side effects and the possibility of late disease recurrence. While there is an opportunity to update current waiver policies for resectable early-stage lung cancer, additional considerations are still required to individualize aeromedical decision-making based on underlying cancer histology, treatment response, side effects of newer therapies, and risk of cancer recurrence after remission. In preserving their fitness for duty, emerging evidence and the continuously evolving treatment landscape will continue to challenge flight surgeons to keep aircrew well-informed of their management options. Low JW. Current lung cancer management and return-to-duty considerations for military aircrew. Aerosp Med Hum Perform. 2026; 97(3):185-193.

Current opinions on lung cancer screening in the Nordic countries: A survey-based study.

Gaps in the Electronic Medical Record May Contribute to Low Participation in Lung Cancer Screening.

Performance validation of a closed loop fully automated AI model for lung nodule stratification in screening cases.

With the rapid development of artificial intelligence (AI), AI-assisted medical imaging analysis demonstrates remarkable performance in early lung cancer screening. However, the costly annotation process and privacy concerns limit the construction of large-scale medical datasets, hampering the further application of AI in healthcare. To address the data scarcity in lung cancer screening, we propose Lung-DDPM, a thoracic CT image synthesis approach that effectively generates high-fidelity 3D synthetic CT images, which prove helpful in downstream lung nodule segmentation tasks. Our method is based on semantic layout-guided denoising diffusion probabilistic models (DDPM), enabling anatomically reasonable, seamless, and consistent sample generation even from incomplete semantic layouts. Our results suggest that the proposed method outperforms other state-of-the-art (SOTA) generative models in image quality evaluation and downstream lung nodule segmentation tasks. Specifically, Lung-DDPM achieved superior performance on our large validation cohort, with a Fréchet inception distance (FID) of 0.0047, maximum mean discrepancy (MMD) of 0.0070, and mean squared error (MSE) of 0.0024. These results were 7.4×, 3.1×, and 29.5× better than the second-best competitors, respectively. Furthermore, the lung nodule segmentation model, trained on a dataset combining real and Lung-DDPM-generated synthetic samples, attained a Dice Coefficient (Dice) of 0.3914 and sensitivity of 0.4393. This represents 8.8% and 18.6% improvements in Dice and sensitivity compared to the model trained solely on real samples. The experimental results highlight Lung-DDPM's potential for a broader range of medical imaging applications, such as general tumor segmentation, cancer survival estimation, and risk prediction.

A0038 Prevalence of kidney cancer in attendees for combined lung and kidney cancer screening by CT scanning

Psychological features and quality of life in low-dose CT lung cancer screening: a comparative analysis with general population data.

Lung cancer in women: current evidence and future research priorities.

Background: Low-dose computed tomography (LDCT) screening reduces lung cancer mortality; however, the effectiveness of screening programs depends not only on detection, but also on completion of downstream diagnostic pathways following a positive screening result. Refusal of recommended invasive diagnostic procedures represents a critical but understudied form of post-screening attrition. Methods: This retrospective observational study was conducted within an organized multicenter LDCT lung cancer screening program in Vojvodina, Serbia. Consecutive participants screened between September 2020 and October 2025 were included. Positive screening was defined as Lung-RADS 4A, 4B, or 4X. Refusal was defined as the absence of any invasive diagnostic procedure within six months following multidisciplinary team recommendation. Demographic, clinical, smoking-related, and perceptual factors were analyzed. Time to invasive diagnostic procedures was assessed for bronchoscopy and surgical treatment. Multivariable logistic regression was used to identify factors independently associated with refusal. Results: Among 10,261 screened individuals, 479 (4.7%) had positive LDCT findings. Of these, 60 participants (12.5%) refused invasive diagnostic evaluation. In multivariable analysis, multimorbidity (OR 3.45, 95% CI 1.61–7.38), previous malignancy (OR 2.92, 95% CI 1.16–7.35), higher cumulative smoking exposure (OR 1.02 per pack-year, 95% CI 1.00–1.03), and screening center (Subotica vs. Novi Sad: OR 2.40, 95% CI 1.21–4.78) were independently associated with refusal of invasive diagnostic procedures. Greater concern about personal lung cancer risk was associated with a lower likelihood of refusal (OR 0.54, 95% CI 0.29–0.99). Time to bronchoscopy differed significantly across screening centers and screening years, whereas time to surgical treatment was comparable across centers and years. Conclusions: Refusal of invasive diagnostic procedures following positive LDCT screening represents a meaningful implementation challenge influenced by both patient vulnerability and system-level factors. Addressing modifiable barriers through improved risk communication and optimization of post-screening diagnostic pathways may enhance diagnostic continuity and strengthen the real-world effectiveness of lung cancer screening programs.

In July 2022, the Australian Medical Services Advisory Committee (MSAC) recommended the establishment of an Australian NLCSP (National Lung Cancer Screening Program), using low-dose computed tomography (LDCT) for the early detection of lung cancer in asymptomatic high-risk individuals. MSAC's recommendations for the NLCSP included core requirements as follows: (i) routine biennial screening, (ii) use of the PanCan risk prediction model for reporting baseline LDCT, and (iii) the use of the most recent version of Lung-RADS for reporting follow-up LDCT. Necessary adaptations were made to incorporate these requirements, resulting in a bespoke protocol for the Australian context. This article summarises the rationale and development of the NLCSP Nodule Management Protocol.

Fibrosis may coexist with emphysema in chronic obstructive pulmonary disease (COPD), but computed tomography (CT) quantification is challenging. Persistent homology (PH), a topological data analysis technique, provides interpretable structural features in grayscale images. By using PH, this CT study aimed to quantify fibrotic lesions in nonemphysematous and emphysematous lungs and to investigate clinical implications of PH-based fibrosis quantification in patients with COPD. The study included subjects from the Lung Cancer Screening (LCS) cohort (n=346) and two prospective COPD cohorts (Kyoto University [KU], n=234; Kyoto-Himeji, n=166). Based on CT value patterns and spatial topology, PH assigned each voxel as fibrotic or non-fibrotic and calculated the percentage of fibrotic lung volume (PH-fibrosis%) in association with visually identified interstitial lung abnormality (ILA) and COPD outcomes. Higher PH-fibrosis% was associated with ILAs in the LCS and KU cohorts. The two COPD cohorts consistently showed significant associations between higher baseline PH-fibrosis% and future exacerbation risk independent of emphysema and airway wall thickness (hazard ratios [HR]: 1.39 and 3.35 for KU and Kyoto-Himeji, respectively). In the KU cohort, higher PH-fibrosis% was significantly associated with increased mortality (HR: 1.94), with a similar trend in the Kyoto-Himeji cohort (HR: 1.86). Longitudinal increases in PH-fibrosis% over median 4.98 years were associated with higher exacerbation frequency and patients experiencing greater increase in PH-fibrosis% subsequently exhibited higher mortality in the KU cohort. PH can be used to quantify fibrotic lesions on CT and PH-fibrosis% could be a prognostic imaging marker in patients with COPD.

Lung cancer screening (LCS) is vital for early detection of lung cancer. Many veterans live in rural areas far from VA medical centers but may receive VA-funded care locally through care in the community (CITC). LCS through CITC may lack the centralized support available at main VA campuses, placing veterans at risk for lower quality care. Does implementation of a centralized process for CITC LCS: reduce screening among ineligible individuals, improve timeliness of care and staff experience, decrease care fragmentation by recapturing imaging and consultative care within the VA, and increase appropriate imaging follow-up and specialty consultation for lung nodules identified through LCS? We conducted a quality improvement initiative to incorporate centralized processes for veterans receiving LCS through CITC. A nurse coordinator served as implementation champion and was responsible for reviewing referrals, confirming eligibility for CITC and LCS, ensuring results were received back to the ordering medical center and ensuring follow-up was conducted according to Lung Imaging Reporting and Data System (LungRADS) guidelines. Quantitative data was compared pre- and post- implementation period for key outcomes (eligibility, timeliness, evaluation of high-risk nodules, care fragmentation). Qualitative data was obtained by interviewing participating staff. In the pre-implementation period, 6.3% (31/489) of patients who completed LCS were ineligible. In the post-implementation period, 14.3% (433/3023) of referred patients were ineligible, and 0 completed imaging. (P = 0.0001). The mean time between CT completion and results received by the ordering clinician or LCS coordinator decreased from 27.6 (19.7-35.5) days to 14.5 (9.3-19.8) days following program implementation (P = 0.0414), with improved guideline adherent follow-up including serial imaging or pulmonary consult for high-risk nodules. More consults were completed at the VA (vs CITC) following program initiation (11.1% vs 88.0%, P = 0.0001). Participating staff felt the implementation process was smooth and were satisfied with the centralized support. Implementing a centralized LCS program for CITC patients resulted in improved guideline-adherent LCS, increased appropriate consultative care, decreased care fragmentation and improved staff experience. Other VA healthcare systems should consider implementing similar centralized CITC-LCS programs.

Development and psychometric evaluation of a decision quality instrument for lung cancer screening decisions (DQI-LCS).

Lung cancer is the leading cause of cancer-related mortality in the United States. Lung cancer screening is recommended to individuals with a history of heavy cigarette smoking; it is proven to be effective in reducing lung cancer-related mortality, but the uptake remains low. In this project, we employ a hybrid model to ensure consistent screening for tobacco use and lung cancer screening eligibility, provision of tobacco cessation care, shared decision making for lung cancer screening, subsequent completion of screening, and navigation to follow-up care as needed, in Northeast Texas. The project is a partnership between a comprehensive cancer center, a university-affiliated hospital system, and a Federally Qualified Health Center. The intervention is designed as a hybrid lung cancer screening program, with a mix of centralized and decentralized features, to deliver high-quality tobacco cessation and lung cancer screening care for individuals in Northeast Texas. Major components of the intervention include training clinicians in shared decision making for lung cancer screening and tobacco cessation interventions; ensuring consistent screening for tobacco use and identification of patients eligible to lung cancer screening; provision of tobacco cessation interventions; and lung cancer screening completion support and navigation for further care, including follow-up testing and lung cancer treatment, as needed. Through a hybrid care model, the project aims to enhance the quality of tobacco cessation care and shared decision making for lung cancer screening, increase screening uptake by eligible patients, and promote adherence to follow-up care and annual screening. The project also contributes to increased awareness of lung cancer and lung cancer screening in the community through dissemination and outreach strategies.

Interstitial lung abnormalities (ILAs) progress radiologically in many patients and may reflect early interstitial lung disease (ILD). Within idiopathic pulmonary fibrosis and other smoking-related ILDs, there is increasing evidence that aberrant airway biology plays a role in disease development and progression. In this study, we sought to investigate associations between radiologic features of airways disease and progressive ILAs that could provide valuable insights into the management of patients at risk for developing ILD. We performed a retrospective study of subjects undergoing low-dose computed tomography (LDCT) for lung cancer screening between January 2016 and August 2022. Adults aged 50-80 years with ≥2 LDCTsperformed ≥24 months apart were included. Demographic data, medical history, and LDCTs were collected. LDCTs were qualitatively analyzed for ILAs and features of airways disease by a thoracic radiologist. Data were analyzed using a generalized estimating equation adjusted for age, sex, pack-years of tobacco, and a radiologic usual interstitial pneumonia pattern. Of 482 subjects, 54% (259/482) were female, and 66% (316/482) were Black. Average age was 64 years. The majority of subjects were current smokers (n = 276, 57%). Thirty-one percent (n = 147) had COPD, and 11% had asthma (n = 56). Median time between LDCTs was 51 (39-61) months. There were 85 subjects with ILAs, and of those, 42 (49.4%) had progressive ILAs. Bronchial wall thickening and mosaic attenuation were associated with ILA progression in adjusted models (odds ratio [OR] = 2.61, 95% CI: 1.08-6.23 and OR = 2.51, 95% CI: 1.02-6.17, respectively). Radiologic features of airways disease, including bronchial wall thickening and mosaic attenuation, wereassociated with ILA progression in subjects undergoing lung cancer screening.

As lung cancer screening is now covered by statutory health insurance and with the goal of early cancer detection, the number of diagnostic and interventional bronchoscopic procedures is expected to increase substantially - in order to facilitate timely treatment and improve patient survival. This trend underscores the growing importance of evidence-based anaesthesiological management in interventional bronchoscopy.This review summarises current anaesthetic strategies, oxygenation and ventilation techniques, and the monitoring modalities used in interventional bronchoscopy. The review critically appraises the available evidence regarding safety, risk profiles, and procedural outcomes.While diagnostic bronchoscopy is commonly performed under local anaesthesia, with or without moderate sedation to improve patient comfort, modern interventional bronchoscopy imposes significantly higher demands on anaesthetic care. Increasingly complex and invasive procedures, such as transbronchial cryobiopsy, airway stent implantation, and endobronchial tumour ablation, require tailored approaches to analgesia, anaesthesia, airway management, and respiratory support, in order to ensure procedural success and patient safety. The shared airway necessitates close interdisciplinary collaboration and the continuous maintenance of adequate oxygenation and ventilation throughout the intervention.Anaesthetic strategies range from various levels of procedural sedation to general anaesthesia with neuromuscular blockade. Airway management options include augmented spontaneous breathing, supraglottic airway devices, infraglottic techniques such as rigid bronchoscopy, endotracheal tubes, and specialised catheters for jet ventilation. In addition to conventional oxygen supplementation, established respiratory support modalities include high-flow nasal oxygen therapy, controlled mechanical ventilation, and jet ventilation, which may be selected or combined - depending on procedural and patient-specific requirements.Individually adapted anaesthetic concepts are essential for minimising procedural complications and optimising outcomes. This requires structured pre-interventional interdisciplinary evaluation and the implementation of standardised peri-interventional strategies. The choice of anaesthetic technique should be individualised, considering patient-related risk factors, comorbidities, underlying pulmonary pathology, and the type and invasiveness of the bronchoscopic procedure.

Aortic and Cardiac Structure From Routine CT Predict Cardiovascular Risk Beyond PREVENT and Coronary Calcium.

Fusing data from CT deep learning, CT radiomics and peripheral blood immune profiles to diagnose lung cancer in a cohort of patients experiencing symptoms.