Overall adherence to lung cancer screening follow-up after a positive low-dose CT exam is less than 50% -- and the odds are even lower among Black people, men, and current smokers, a study published November 3 in JAMA Network Open has found.
The findings confirm previous research that has shown disparities in lung cancer screening follow-up, and suggest that the full benefits of screening aren't being realized, wrote a team led by Dr. M. Patricia Rivera of the University of Rochester Medical Center in Rochester, NY.
"Maximizing the benefits of lung cancer screening requires timely follow-up after a positive screening test," Rivera and colleagues noted.
The American College of Radiology (ACR) recommends follow-up screening for individuals with Lung-RADS categories of 3 (probably benign, within 6 months), 4A (suspicious, within 3 months), or 4B or 4X (very suspicious, within 4 weeks). With these categories and follow-up protocols in mind, Rivera and colleagues evaluated rates of compliance and explored whether there are particular factors associated with these rates.
The study included 685 patients who underwent low-dose CT lung cancer screening between January 2015 and July 2020 and had Lung-RADS categorizations of 3, 4A, or 4B or 4X. Of these patients, 18% were Black, 82% were white, and 51.4% were male.
Overall adherence to recommended lung cancer screening follow-up was 42.6%. Rates varied by Lung-RADS category and were higher for more suspicious findings. When the follow-up time was extended, compliance rates increased.
| Follow-up compliance rates in patients with positive lung cancer screening results | |||
| Factor | Lung-RADS 3 | Lung-RADS 4A | Lung-RADS 4B or 4X |
| Overall adherence | 30% | 49.5% | 68% |
| Extended follow-up time | 68.6% (from six months to within nine months) | 77.3% (from three months to within five months) | 80.5% (from 30 days to within 62 days) |
| Factors contributing to lower odds of follow-up | Current smokers (odds ratio*, 0.48) | Blacks (odds ratio, 0.35) | Current smokers (odds ratio, 0.31) |
The researchers also found that men with Lung-RADS scores of 4B or 4X were less likely than women with these scores to undergo follow-up (odds ratio, 1.09 vs. 2.82).
Compliance with lung cancer screening follow-up must be improved, according to the authors.
"Efforts should be made to better define the recommended timeline for follow-up of high-risk screen-detected nodules, Lung-RADs 4B and 4X, and to understand why recommended follow-up after a positive result are lower in Black individuals, male individuals, and those who currently smoke," they concluded.
![Images show the pectoralis muscles of a healthy male individual who never smoked (age, 66 years; height, 178 cm; body mass index [BMI, calculated as weight in kilograms divided by height in meters squared], 28.4; number of cigarette pack-years, 0; forced expiratory volume in 1 second [FEV1], 97.6% predicted; FEV1: forced vital capacity [FVC] ratio, 0.71; pectoralis muscle area [PMA], 59.4 cm2; pectoralis muscle volume [PMV], 764 cm3) and a male individual with a smoking history and chronic obstructive pulmonary disorder (COPD) (age, 66 years; height, 178 cm; BMI, 27.5; number of cigarette pack-years, 43.2, FEV1, 48% predicted; FEV1:FVC, 0.56; PMA, 35 cm2; PMV, 480.8 cm3) from the Canadian Cohort Obstructive Lung Disease (i.e., CanCOLD) study. The CT image is shown in the axial plane. The PMV is automatically extracted using the developed deep learning model and overlayed onto the lungs for visual clarity.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/03/genkin.25LqljVF0y.jpg?auto=format%2Ccompress&crop=focalpoint&dpr=2&fit=crop&h=167&q=70&w=250)
