One Appointment, Two Opportunities: What Mammography Can Teach Us About Lung Cancer Screening
November 4, 2026
Every year, millions of women make time for an important preventive health appointment: their mammogram. But what if that same visit could also help identify women who may benefit from lung cancer screening?
A new study led by thoracic surgeon and friend of GO2 for Lung Cancer, Jeffrey B. Velotta, MD, FACS, and colleagues at Kaiser Permanente Northern California suggests that it can, and that doing so could help close an important gap in lung cancer screening.
The study, “Missed by a Pack: Underreported Smoking History Leads to Lung Cancer Screening Gap During Mammography,” looked at women undergoing routine screening mammography and asked a simple question: Could the mammogram appointment also be an opportunity to identify women who are eligible for lung cancer screening but have been missed? The answer was yes.
A missed opportunity for screening
Researchers asked women arriving for screening mammograms to complete a brief survey about their smoking history. Of the 1,299 women included in the study, 19 met U.S. Preventive Services Task Force (USPSTF) criteria for lung cancer screening based on the information they provided. Yet 7 of those 19, or 37%, had no previous lung cancer screening counseling or low dose CT (LDCT) documented in their electronic health record.
In other words, more than 1 in 3 women whom the survey identified as eligible for lung cancer screening had been missed by existing systems.
One major reason was surprisingly straightforward: their smoking histories weren't fully or acurately captured in their electronic health records.
For 3 of the 7 women, the electronic health record underestimated their smoking history. For another 3, information about pack-years (a measure of cumulative smoking exposure) was missing. One woman had the correct smoking history documented but still had no record of lung cancer screening counseling or an LDCT order.
That matters because eligibility for lung cancer screening depends heavily on having an accurate smoking history.
The information collected can determine who gets screened
The USPSTF currently recommends annual lung cancer screening with LDCT for adults ages 50 to 80 who have at least a 20 pack-year smoking history and currently smoke or quit within the past 15 years.
But determining whether someone meets those criteria isn't always as easy as it sounds.
People's smoking patterns can change over a lifetime. Someone may have smoked different amounts at different ages, stopped and restarted, or quit years ago. Electronic health records may not capture all of that information, particularly when smoking history is recorded in a single field or hasn't been updated over time.
The study found that a patient's self-reported smoking history could provide information that wasn't readily captured in the standard electronic health record. The authors concluded that incorporating standardized smoking history questions into mammography workflows could help identify more women who should be considered for lung cancer screening.
And the mammogram appointment offers a particularly interesting opportunity to do it.
Meeting people where they already are
Breast cancer screening is a familiar part of preventive healthcare for millions of women. Lung cancer screening is not.
The researchers point to the significant difference between participation in breast and lung cancer screening as one reason to consider connecting the 2.
Instead of creating an entirely separate opportunity to reach someone who may be eligible for lung cancer screening, healthcare systems could potentially build on an appointment patient are already making.
A few additional questions at mammography check-in could prompt a conversation with a healthcare provider about lung cancer risk and whether screening is appropriate.
This isn't about replacing one screening with another or assuming that everyone receiving a mammogram needs a lung cancer screening. It's about making better use of an existing healthcare touchpoint to ensure people who may benefit from screening aren't overlooked.
Screening only works when people are reached
At GO2 for Lung Cancer, we know that finding lung cancer earlier can make an enormous difference.
LDCT screening can detect lung cancer before symptoms appear, when there may be more treatment options and a greater opportunity for cure. Yet too many people who are eligible for screening never receive it.
There are many reasons for that gap, including lack of awareness, stigma associated with smoking, access barriers, and inconsistent or incomplete smoking histories. The study authors note that these barriers continue to limit lung cancer screening even as other cancer screening programs have become a routine part of preventive care.
Closing that gap will require more than asking individuals to know whether they qualify. It also means building healthcare systems that are better at finding people who may benefit from screening and making the next step easier.
Connecting lung cancer screening conversations with mammography is one promising example.
Know your history and ask about screening
For patients, this research also highlights the importance of knowing and sharing your complete smoking history with your healthcare team.
If you currently smoke or have smoked in the past, talk with your healthcare provider about your history, including approximately how much you smoked and for how many years. Don't assume that because you quit years ago or because your smoking history is already somewhere in your medical record your provider has all the information needed to determine whether you should be screened.
And ask the question directly: Should I be screened for lung cancer?
A routine mammogram may seem like an appointment focused on just 1 part of your health. Research like this reminds us that every interaction with the healthcare system can also be an opportunity to look at the whole person and make sure another lifesaving screening opportunity isn't missed.