Lisa Carter-Bawa, PhD, MPH, APRNa,b ∙ ∙ Julie A. Barta, MDd
Introduction
Lung cancer has long stood as the most formidable cancer killer, burdened not only by late-stage diagnoses but also by decades of stigma and fatalism. Today, however, the landscape is shifting. Advances in screening, therapeutics, and survivorship have created a new reality; lung cancer is treatable, survivable, and increasingly understood as a chronic disease for many. The accompanying editorial from the American Cancer Society National Lung Cancer Roundtable [1] chronicles this progress and the collaborations that have fueled it. This issue of the Journal of the American College of Radiology builds on that foundation, challenging radiology to expand its role from early detection to system transformation.
Radiology as a Catalyst for Integration
The articles in this issue collectively underscore that radiology is no longer a siloed specialty. Instead, radiology functions as a hub, integrating screening into existing cancer pathways, coordinating care across disciplines, and linking patients to prevention, diagnostics, and treatment. Radiology departments are now touchpoints for tobacco cessation, gateways for biomarker testing, and connectors to survivorship resources. This evolution demands that radiology practices not only interpret images but also develop collaborations to design interdisciplinary systems that reduce fragmentation and improve continuity of care.
Shifting From Volume to Value
A crosscutting theme reflected in these contributions is the move from counting scans to measuring impact. Lung cancer screening is not merely about increasing uptake; it is about ensuring that those who are screened are reached equitably, managed appropriately, and supported holistically. The science of lung cancer screening effectiveness is well established, but its value will be determined by how well programs close gaps for rural patients, underserved populations, and communities historically marginalized by health care. For radiology, this means embedding equity into workflow, reimbursement advocacy, and quality improvement, not as add-ons, but as core metrics of success. In addition, measurement of screening outcomes including adherence, radiation dose, and potential harms remains critical for understanding the net benefit of LCS for high-risk individuals.
Confronting the Human Dimensions of Screening
Perhaps most importantly, the work highlighted here reminds us that lung cancer screening is not simply a technical procedure, it is an emotional and social experience. Patients bring fear, uncertainty, and lived histories of stigma into the radiology suite. Anxiety about scans and results, compounded by stigma tied to smoking, can undermine trust and adherence. Radiology practices have the opportunity to counter these forces by designing environments that prioritize empathy, clarity, and respect. Small but intentional changes in how results are communicated, how patients are greeted, and how teams are trained can profoundly shape patient experience, facilitating ongoing screening participation over time that is essential to the early detection of lung cancer.
The Imperative of Innovation and Implementation
From predictive analytics and artificial intelligence-enabled surveillance to pragmatic trials of surveillance intensity, this issue also illustrates how innovation must go hand in hand with implementation. New tools and technologies will not matter if they are not deployed in ways that are usable, affordable, and aligned with patient needs. The future of lung cancer-related screening lies not only in refining imaging technology but also in embedding those advances into sustainable, patient-centered systems that work across varied practice settings—from academic centers to rural clinics.
The Articles
The first set of articles realistically assesses our ability to identify either individuals eligible for screening due to smoking exposure or individuals with environmental exposures associated with lung cancer [2-6]. The next set of articles explores leveraging the higher adherence mammography screening to increase lung cancer screening [7-10]. The next group of articles describes community-based interventions to increase lung screening as well as how state-level policy can support increased screening and diagnosis [11-14].
Lung cancer screening is not entirely benign. We provide a series of articles discussing the harms of screening including “scanxiety” and managing radiation dose [15-18].
The final set of articles deals with some of the remaining issues in screening such as system operability, difficulties in collaboration across the specialties in rural practices, and cannabis use among those undergoing lung screening [19-23].
A Moment of Responsibility
Together, the articles in this issue paint a clear picture: lung cancer screening has matured from a research intervention into a public health imperative. The question is no longer whether lung cancer screening saves lives—it does—but how we ensure that its benefits are realized broadly, equitably, and with dignity. Radiology is uniquely positioned to lead this charge.
The challenge before us is to transform lung cancer care from one defined by stigma and loss to one characterized by survivorship and hope. Doing so requires radiology to embrace its expanded role—not just as detectors of disease, but as architects of systems, stewards of equity, and champions of patient dignity. The work captured in this special issue shows that the path forward is not only possible but already under way.
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