In honor of Lung Cancer Awareness Month in November, I wanted to bring to our community’s attention the importance of lung cancer screening and multidisciplinary care.
Lung cancer is the deadliest form of cancer, and yet, screening tests are not utilized as frequently as they should be, leading to excess death and disability here in New Hampshire. There are more deaths from lung cancer each year than there are from breast cancer, colon cancer and prostate cancer combined. Data from 2025 from the American Cancer Society estimates that in the U.S., there were more than 226,000 new cases of lung cancer and more than 124,000 deaths per year. Our residents in New Hampshire are at increased risk for lung cancer due to an aging population, tobacco smoking rates and environmental factors such as air pollution and radon from the ground.
Statistics from the American Lung Association demonstrate that five-year survival rates following lung cancer diagnosis show significantly improved survival with early or localized disease compared to metastatic disease, in which the cancer has spread to other organs. This pattern of early detection saving lives is similar for other cancer types, such as colorectal cancer and breast cancer, where screening programs have been well-established and generally pursued.
For example, consider breast cancer screening with mammography. The New Hampshire Department of Health and Human Services documents annual screening for women in Medicaid programs between the ages of 50 and 74. in 2023, 56% of women received screening, with commercial-insured patients at 78%. These screening rates are lower than ideal and should be optimized further for the prevention of breast cancer-related morbidity and mortality, with extensive work ongoing through multiple health care venues and public advocacy organizations across the state. However, lung cancer screening rates are much worse and lag far behind mammography.
Lung cancer screening with annual low-dose CT scans of the chest for current or recent-former smokers has been a standard of care recommendation from the United States Preventive Services Task Force since 2013. The Task Force revised the eligibility criteria in 2021 to include ages 50 through 80 with 20 pack-years of tobacco use who are current or former smokers quitting within the past 15 years. Despite this guidance, New Hampshire-specific data from the American Lung Association show that only 16.9% of eligible Granite Staters received screening in 2024. The national leader in this statistic is Rhode Island at 28.6% screened, with our immediate neighbors to the south, Massachusetts, screening 24.2% of eligible residents. In specific geographic regions of the country around institutions that can significantly impact screening rates, there is a corresponding fall in lung cancer mortality due to finding cancers at an earlier and more curable stage.
Once an abnormal imaging exam is obtained that is concerning for lung cancer, the patient is best evaluated by a multidisciplinary review, including pulmonologists, thoracic surgeon, and radiologists, to determine next steps in investigation and management. Additional imaging tests and biopsy approaches would be considered when appropriate. Due to advances in technology with robotic-assisted bronchoscopy, the diagnosis and staging of early-stage cancers have become more efficient and safer. With the use of these technologies, surgical resection of the cancer can also be facilitated to allow for less normal lung tissue to be removed, and shorter hospital stays following the operation.
Nonsurgical approaches such as stereotactic ablative radiotherapy can be considered for early-stage lung cancer patients for whom surgical resection would be inappropriate. Consultations with medical oncologists and radiation oncologists are sought during this multidisciplinary review process. Furthermore, nurse navigators can provide invaluable support and guidance to patients throughout their evaluation and treatment. For those patients diagnosed with later-stage disease, there are currently more treatment options than there have been in the past, with less toxic therapies that are improving patientsโ survival and quality of life. However, our best bet remains to catch it earlier.
This Lung Cancer Awareness Month (and throughout the year), I would recommend that all current or former smokers discuss with their primary care provider if they are eligible for lung cancer screening. For current smokers, I would encourage reaching out to many of the state’s services to support quitting. By improving screening rates and adopting multidisciplinary care, we can save lives in our community.
Martin Black is a pulmonologist at Concord Hospital.