Participation in lung cancer screening remains modest among eligible women despite high engagement with breast screening. Leveraging that attendance provides a practical route to reach people at risk. An initiative aligned with screening mammography evaluated whether identifying women eligible for low-dose CT (LDCT) and coordinating access could lift participation. Conducted at two academic centres over focused outreach periods, the programme embedded eligibility checks into mammography workflows, notified clinicians and simplified scheduling, including same-visit LDCT where available. The approach was associated with higher baseline and total LDCT activity in women during outreach, while activity for men over the same intervals remained largely unchanged. The results indicate that coordination within established breast screening pathways can address missed opportunities in lung screening.
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Eligibility Pathway and Outreach Design
Eligibility was assessed for women attending screening mammography between November 2019 and December 2022. Criteria initially followed prevailing recommendations for age and tobacco exposure, then were broadened in 2021 to include a younger starting age and a lower cumulative smoking threshold. Exclusions comprised metastatic malignancy, a recent lung cancer diagnosis, symptoms suggestive of lung cancer and prior LDCT enrolment.
Two operational models were tested. One site implemented a hybrid pathway led by a respiratory team. Age and tobacco exposure were captured through electronic health record (EHR) review and brief on-site surveys in mammography areas. Team members contacted eligible women directly, facilitated LDCT scheduling and tracked results with multidisciplinary oversight to support annual adherence. The second site used a centralised imaging-led model. Staff reviewed EHRs before mammography at breast screening centres that also performed LDCT, flagged likely eligible women to referrers through the EHR and activated referrals to a lung screening programme. Same-visit LDCT in the same facility as mammography was available, and the centralised team delivered shared decision making, scheduling, interpretation, tracking and follow-up. Both sites placed awareness materials in mammography locations to prompt interest and questions among attendees.
Uptake Gains Among Women Attending Breast Screening
Across both centres, 32,165 screening mammography records were assessed, identifying 1,569 women as eligible for LDCT. Most had not previously undergone lung screening, indicating a sizeable pool of missed opportunities reachable within breast imaging services. During the targeted outreach periods, monthly baseline LDCT activity for women increased at each site, and total monthly activity for women (baseline plus annual) rose in parallel. These gains met or exceeded site-specific enrolment targets. In contrast, men’s baseline activity over the same periods did not show a corresponding significant change, supporting the interpretation that the observed increases in women reflected the targeted coordination within mammography settings rather than background trends.
Operational details contributed to uptake. Pre-visit EHR review and automated notifications ensured that eligibility prompts reached clinicians before or at the time of mammography, reducing delays and missed referrals. Same-visit LDCT in co-located facilities lowered barriers by converting intent into action within a single appointment. Direct patient outreach and visible on-site materials further supported decision making and engagement. Women who completed baseline LDCT during outreach had smoking exposures consistent with eligibility thresholds, and the average age among those imaged aligned with programme criteria. While site workflows differed, both structures integrated lung screening steps into established mammography processes, allowing incremental tasks to be absorbed without major disruption.
Programme Structure, Generalisability and Limitations
The hybrid and centralised models each produced improvements, indicating that different organisational pathways can be effective when they share core features: systematic eligibility identification, timely clinician prompts, patient-centred scheduling and reliable tracking. Placing the intervention within mammography services aligns with a setting where many eligible women already present for preventive care, enabling focused outreach to a well-engaged population. Using men’s activity as a contemporaneous comparator helped account for the broader broadening of eligibility criteria in 2021, clarifying the contribution of the coordinated approach embedded in breast screening.
Several limitations frame interpretation. The initiative used a prospective quasi-experimental design rather than randomisation. A decentralised model was not evaluated, so outcomes without programme support or interventional automation remain uncertain. Future work could apply block randomisation across multiple providers or facilities to strengthen causal inference and test scalability. Nonetheless, operational markers point to feasibility: eligibility can be identified through routine EHR review, referrals can be initiated within existing systems and co-location enables same-visit imaging. These elements, combined with consistent tracking for follow-up, shaped a replicable template adaptable to local resources and governance.
Embedding lung screening coordination into mammography pathways identified a substantial cohort of eligible women and increased participation in LDCT during focused outreach. Improvements were achieved under two distinct programme structures, met or surpassed local targets and were not mirrored in men over the same timelines. For healthcare leaders seeking to raise lung screening uptake among women at risk, aligning eligibility checks, clinician notifications and streamlined access with breast screening offers an actionable route that fits existing workflows and supports earlier detection.
Source: Journal of the American College of Radiology
Image Credit: iStock
