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The gap between reality and perception around lung cancer mortality for women couldn’t be wider.

Lung cancer represents 21% of all cancer-related deaths, surpassing breast cancer at 15%. But only 8% of adults recognize it as the leading cause of cancer death in women.

Conversely, the national rate of lung cancer screening is remarkably low. Only 16% of eligible individuals undergo low-dose CT (LDCT), compared to more than 80% of women who adhere to mammography screening. Although early detection of lung cancer remains patients’ best chance for survival, the main barrier to improve cure rates lies in identifying and engaging eligible patients early.

Confusing screening protocols

While breast cancer screening eligibility is straightforward — any woman over 40 qualifies — lung cancer screening is governed by a more complicated and inconsistent set of criteria.

To be eligible for lung screening, patients must meet all of the following criteria:

1. Are between age 50 and 80 (77 for Centers for Medicare & Medicaid ÍŃŇÂÖ±˛Ą).
2. Currently smoke, or used to smoke but quit in the last 15 years.
3. Have smoked a minimum of 20-pack years.

The American Cancer Society recently recommended eliminating the 15-year quit threshold altogether. This lack of simplicity in screening criteria makes it more difficult to identify those who qualify — and easier for patients to miss appropriate screenings.

“There are a lot of boxes to check in order to get a lung cancer screening,” explains Nicole Geissen, DO, thoracic surgeon at Rush. “Our main priority is to make them more accessible for patients who need them.”

Paired screening

To close this gap, Rush launched the Pink and Pearl campaign, a multidisciplinary initiative that integrates lung cancer risk assessment into the mammography workflow. The concept is simple but strategic: Use the high engagement rates of breast cancer screening to identify women who may also qualify for lung cancer screening.

Rush clinicians give patients a brief intake questionnaire that they complete during mammogram appointments; it screens patients’ smoking history and other lung cancer risk factors. Patients who meet preliminary criteria are referred to Rush’s team of lung cancer screening nurse navigators. These navigators confirm eligibility, walk patients through shared decision-making conversations, coordinate with primary care physicians, and help schedule the exam.

This approach is already producing measurable results. From late October 2023 through June 2024, 392 women were identified as candidates for lung cancer screening through the campaign. Of those, 210 met full screening criteria. Roughly half were already enrolled in a screening program; the rest either had new orders placed or declined screening after discussion.

Overall, Rush’s lung cancer screening rate among eligible patients has climbed to 20%, which is higher than the national average of 16%. In short, the campaign is reaching patients who would otherwise be missed.

“We’ve been very pleased with the effectiveness of Pink and Pearl and are looking to carry that momentum forward to help more patients get screened,” Dr. Geissen says.

Multidisciplinary care in action

Should a patient be diagnosed with lung cancer, they benefit from Rush’s integrated, multidisciplinary tumor board model. Every case is reviewed by a team that includes thoracic surgeons, radiation oncologists, pulmonologists and medical oncologists, ensuring that patients’ treatment plans reflect the latest guidelines and are tailored to their clinical and personal circumstances. When detected early, lung cancer can be treated with curative intent, often with minimally invasive surgery or stereotactic radiation.

The success of the Pink and Pearl campaign illustrates the value of combining lung cancer screening with more broadly utilized preventive care pathways. Rush has built a replicable model for improving screening rates, reducing disparities, and catching cancer when it's most treatable.

For providers seeking to refer patients or learn more about Rush’s lung cancer screening process, please contact Annie Lally, program manager of lung cancer screening at Rush, at (312) 563-2360 or call the lung screening line at (312) 947-LUNG (5864).