Early detection is our most powerful weapon against lung cancer. As physicians, staying ahead of evolving guidelines and streamlining clinical workflows are critical to moving the needle on survival rates. Amina Pervaiz, MD, Pulmonologist, Member, Thoracic Oncology Multidisciplinary Team, Barbara Ann Karmanos Cancer Institute, shares how our multidisciplinary team approaches early detection, focusing on clear guidelines and actionable steps can help us overcome diagnostic delays.
Navigating the Evolving Screening Landscape
The core strategy remains annual low-dose computed tomography (LDCT) for high-risk patients, but the definition of “high-risk” is expanding. It’s vital to understand the differences between the major guideline bodies, especially when discussing eligibility with patients and navigating insurance coverage.
“The biggest change we’re seeing is the recognition that cancer risk doesn’t just evaporate 15 years after someone quits smoking,” Dr. Pervaiz observes. “While the USPSTF and CMS are still the benchmarks for insurance coverage, covering adults aged 50–80 (or 77 for CMS) with a ≥20 pack-year history who quit within the last 15 years, the risk models tell a broader story.”
The American Cancer Society (ACS) and the NCCN 2025 Insights reflect this broader risk by removing the 15-year quitting cap. “We need to adopt the spirit of the ACS and NCCN guidelines, particularly when doing shared decision-making,” she advises. “A long-quit former smoker may not meet the federal criteria for guaranteed payment, but they are still at elevated risk and deserve a thorough discussion about screening.”
Reducing Diagnostic Friction: Strategies for Timeliness
A positive screening result is only beneficial if it leads to timely diagnosis and treatment. In Dr. Pervaiz’s experience, the biggest threat to early detection isn’t the screening technology; it’s the diagnostic delay that follows an abnormal finding.
1. Rigorous Use of Lung-RADS and Automated Tracking
“We must treat Lung-RADS not just as a reporting tool, but as a management directive,” Dr. Pervaiz emphasizes.
- Adherence to Intervals: Physicians should strictly adhere to the Lung-RADS v2022 management intervals, such as the typical three-month follow-up for a Lung-RADS 4A nodule. Delays here can mean a stage I cancer becomes stage II or worse.
- Systemic Recall: “Relying on a busy physician or patient to remember a three-month follow-up is a recipe for failure,” she notes. “The solution is an LDCT/nodule registry with automated recalls. These systems, whether custom-built or integrated into the EHR, drastically improve the completion rate of recommended imaging.”
2. Standardization and Dedicated Navigation
The most successful programs standardize the path from detection to diagnosis.
- Nurse Navigation: “A screening coordinator or nurse navigator is not a luxury; they are essential staff,” Dr. Pervaiz states. “They are the ‘closers.’ Their job is to manage the patient, close the loop on abnormal results, schedule the PET or bronchoscopy, and address barriers like transportation or prior authorization delays. They are the consistent driver of timeliness.”
- Rapid Nodule Pathway: Implement a defined rapid nodule clinic pathway with explicit service level agreements (SLAs). “We aim for clear, minimal timeframes from a positive LDCT to the diagnostic CT to the tissue diagnosis. This means having EHR order sets keyed to Lung-RADS to streamline follow-up imaging and consultation.”
3. Minimizing Administrative Roadblocks
“Administrative friction is an unacknowledged cause of diagnostic delay,” Dr. Pervaiz says. “We look for ways to reduce it.” Working proactively with radiology and payers to establish pre-approved protocols for guideline-concordant follow-ups can eliminate time wasted on prior authorizations, especially for the critical three-month interval scans.
Looking Beyond Traditional Risk Categories
While LDCT remains the gold standard, the field is exploring ways to improve risk stratification and efficiency.
- Risk-Model Selection: Using tools like the PLCOm2012 risk-prediction model can identify high-risk individuals who don’t meet the strict age/pack-year criteria. This provides an avenue for expanding screening coverage in a risk-adapted and efficient manner.
- Role of AI: “AI and radiomics are promising for predicting future risk or guiding interval adjustments, but they are currently adjunctive tools,” Dr. Pervaiz advises. “They should not replace our current guideline criteria, but they certainly belong in our research and quality assurance frameworks.”
- The Future of Blood Tests: While blood-based or MCED (multi-cancer early detection) tests are gaining attention, Dr. Pervaiz is cautious. “Right now, they are not a replacement for LDCT. Current guidance emphasizes that they should be used in conjunction with imaging and clinical context, and ideally within clinical trials, until we have more robust evidence on their impact outside of a research setting.”
In summary, effective lung cancer screening requires a commitment to the latest guidelines, coupled with a robust, automated, and human-supported system to ensure zero delays from finding an abnormality to achieving a final diagnosis.