Governor Kathy Hochul in December passed legislation to increase access to screening and diagnostic services for lung cancer, an important step in breaking down financial barriers that translate to greater lung cancer mortality for New Yorkers. It is fantastic news.
As a physician and surgeon who’s been caring for lung cancer patients for more than a decade, I’ve borne witness too many times to personal, social, structural, cultural, and economic hurdles surrounding diagnosis and treatment that sadly result in delayed diagnosis and poorer outcomes. Though incidences of many kinds of cancer are influenced by lifestyle choices, the stigma and shame of the disease have an outsized effect on lung cancer outcomes.
Stigma and shame are reinforced by decades of public messaging, uneven regulation of nicotine products, fragmented insurance policies, and a health care system that places the burden of action almost entirely on patients. On top of these barriers, the guilt and fear associated with the link between smoking and lung cancer drive screening and treatment adherence rates down even further. Stigma even affects primary care doctors, who, though often concerned with patients’ smoking cessation, may not be aware of the incredible benefit of low-dose CT screening despite strong evidence that it reduces mortality from lung cancer.
Consider one patient of mine, a 68-year-old woman who smoked for more than 50 years. Between 2017 and 2019, she completed three annual screenings, then didn’t return until 2025.
What brought her back? During a routine mammogram visit, her physician raised lung screening as an equally important preventive test, given her smoking history. Framed as standard care rather than moral judgment, she agreed to return. Her absence from screening for six years wasn’t due to lack of access or information alone. It was driven by fear of what might be found, and shame that if something were found, it would confirm a personal failure.
In comparison to the roughly 80% of women aged 50-74 screened for breast cancer, lung cancer screening data shows that only 18.2% of all individuals eligible were screened. Underutilized screening is a significant factor driving lung cancer killing more people annually than breast and colorectal cancer combined.
Lung cancer screening is uniquely vulnerable to stigma because it relies on disclosure of smoking histories. Insurance coverage depends on narrow eligibility criteria, prior authorization, and restrictions on facilities.
In our Brooklyn community, these challenges are further amplified. Lung cancer screening is not considered part of routine preventive care among our culturally diverse patients where cancer is often feared and open discussions about it avoided. The concept of screening before symptoms appear may be unfamiliar. Language barriers, mistrust of institutions, and competing socioeconomic demands all reduce commitment. Yet policy frameworks rarely account for these realities.
The result is predictable: lung cancer remains the leading cause of cancer death, despite being one of the few cancers with proven screening tools that can detect the disease early.
Fortunately, we have made incredible strides in caring for patients with lung cancer. Since the mid 1990s, the five-year relative survival rate for lung cancer has nearly doubled to 28%. For those with screening-detected lung cancers, survival rates are 80% or better.
But without taking advantage of available technologies, these advances mean little. To curb lung cancer mortality, we must treat screening as a public health obligation: normalizing it alongside mammography and colonoscopy; aligning insurance policies with best practices; and investing in comprehensive screening models. All current and past smokers should discuss with their doctor a referral for screening, and maintain screening appointments annually until age 80.
While lung cancer treatments have become more effective, around 21% of patients diagnosed receive no treatment at all. At a time in history when people are living for many more years than we ever thought possible after a lung cancer diagnosis, and many lung cancer deaths are preventable, replacing stigma with knowledge ensures all lung cancer patients and those at risk receive the treatment they deserve.
Dr. Jason Shaw, MD, is the director of General Thoracic Surgery at Maimonides Medical Center in Brooklyn, and director of the Maimonides Lung Cancer Screening Program.
