Low-dose CT screening has been promoted as a way to cut lung cancer deaths, but new national data show that nearly 40% of Medicare patients with abnormal findings never receive the follow-up imaging or procedures recommended by guidelines. Only 59.7% got guideline-concordant care, while 32.3% had less intensive and 7.9% more intensive follow-up than advised, raising concerns about delayed diagnoses and eroded mortality benefits.
Those shortfalls do not fall evenly. Less intensive follow-up was more likely for Black, Asian, and Hispanic patients, as well as current smokers and people undergoing baseline screening, with odds ratios ranging from 1.26 to 1.66 for Lung-RADS category 3. For communities already carrying disproportionate lung cancer burdens, missed or delayed follow-up threatens to deepen existing racial health disparities in detection and survival.
Researchers analyzed data from 64,555 adults ages 65 and older in the American College of Radiology Lung Cancer Screening Registry linked to Medicare claims, all with a first positive low-dose CT between 2015 and 2021. They found that adherence to follow-up recommendations improved with higher Lung-RADS scores, yet gaps persisted even among those at greatest risk.
“To realize the benefits of LCS lung cancer screening, adequate follow-up of screen-detected abnormalities is essential,” wrote lead author Paul F. Pinsky, PhD, and colleagues. The team concluded that “the main opportunity for improvement among U.S. LCS participants is ensuring timely and appropriate follow-up,” underscoring that the most urgent task is fixing underuse, not overuse.
