MISINFORMATION may be discouraging patients and clinicians from using lung cancer screening, despite strong evidence that it saves lives and reduces mortality among high-risk populations, according to leading US medical societies addressing flawed interpretations of screening harms.
Why Lung Cancer Screening Remains Underused
Lung cancer screening using low dose CT scans is recommended for individuals at elevated risk, particularly long-term smokers, yet uptake remains low. Experts argue that misunderstandings about lung cancer screening risks have contributed to hesitation in offering or accepting scans. Less than one in five eligible individuals currently undergo screening, despite demonstrated survival benefits.
In a joint statement, the Society of Thoracic Surgeons, the American Society for Radiation Oncology, and the American College of Radiology warned that repeated misreporting in peer reviewed literature has distorted perceptions of lung cancer screening safety. The authors emphasised that inaccurate data can fuel fear of overdiagnosis, unnecessary procedures, and radiation related cancers, ultimately limiting access to a potentially lifesaving intervention.
Examining the Evidence Behind Screening Harms
Reviewing recent publications, the authors identified three recurring methodological errors affecting lung cancer screening. First, several studies overstated downstream imaging and procedural complications following screening. Second, they highlighted widespread confusion between false positive rate and false discovery rate.
In the National Lung Screening Trial, the per screen false positive rate was 26.6% at baseline and declined in later rounds. However, more than 40 publications misquoted this figure as 96.4%, which actually represents the false discovery rate. This misrepresentation creates the impression that nearly all screened individuals undergo unnecessary testing. When Lung-RADS criteria are applied, the baseline positive screen rate falls from 27.6% to 10.6%.
Third, the statement challenged inflated estimates of cancer risk from CT radiation. A recent modelling study projected 103,000 new cancers from 93 million CT scans in 2023, a 255% increase compared with 2007 estimates. The authors argued these projections rely on inappropriate extrapolation from atomic bomb survivor data and assumptions that overestimate long term risk.
Implications for Clinical Practice and Policy
The authors concluded that lung cancer screening reduces lung cancer specific mortality and improves overall survival when implemented correctly. Overstating harms risks undermining public trust and discouraging appropriate screening referrals. They urged clinicians, researchers, and journals to apply rigorous methodological standards and present screening risks in proper clinical context.
Accurate communication, they argued, is essential to ensure lung cancer screening is offered to those most likely to benefit, rather than withheld due to unfounded fears driven by misinformation.
Reference
Tupper HI et al. Misinformation and overestimation of computed tomography lung cancer screening harms-methodology matters: a joint statement from The Society of Thoracic Surgeons, the American Society for Radiation Oncology, and the American College of Radiology. Ann Thorac Surg. 2026;DOI:10.1016/j.jacr.2025.12.023.
