Imagine receiving a devastating lung cancer diagnosis, only to discover you weren't even eligible for screening. This is the stark reality for a growing number of people, and it's prompting a critical re-evaluation of current screening guidelines.
November 20, 2025, 5:16 PM EST
In 2024, Kara Goodwin, a vibrant and active marathon runner, began experiencing persistent pain in her arm and shoulder. Initially, doctors diagnosed her with bicep tendinitis and frozen shoulder, attributing it to overuse from her rigorous training schedule. Living in Brooklyn, New York, Kara embodied health and vitality, making the subsequent diagnosis all the more shocking.
However, when the pain refused to subside after two months, an MRI revealed a far more sinister cause. "They could visibly see the giant tumor that was shattering my humerus bone from the inside out," Kara recounted. At just 39 years old, she was diagnosed with stage 4 lung cancer that had metastasized to her bones. "It was quite shocking as a marathon runner," she said, highlighting the unexpected nature of the diagnosis. "I have no family history of cancer," she added, further emphasizing the anomaly of her situation.
While Kara's cancer is treatable, it's not curable. The treatments aim to control the cancer's progression, but eventually, they are likely to lose their effectiveness. This underscores the importance of early detection, as lung cancer is significantly more curable when discovered in its initial stages, according to the American Lung Association.
But here's where it gets controversial... Kara wouldn't have been eligible for lung cancer screening under current guidelines. These guidelines, established by the U.S. Preventive Services Task Force, primarily target individuals aged 50 to 80 with a significant smoking history – specifically, those who smoked a pack a day for 20 years and either still smoke or quit within the past 15 years.
Now, consider this: up to 20% of lung cancer cases occur in individuals who have never smoked or used any form of tobacco, according to the American Cancer Society. This significant percentage highlights a critical gap in the current screening protocols. A recent study published in JAMA Network Open further emphasizes this issue, suggesting that the existing guidelines are missing a substantial portion of lung cancer cases.
Dr. Ankit Bharat, executive director of the Northwestern Medicine Canning Thoracic Institute in Chicago and lead author of the study, points out that the perception of lung cancer as a disease exclusive to older men and lifelong smokers is outdated. "Every day, we are seeing patients who’ve never smoked, who may have had passive smoking exposure, they’re coming with advanced lung cancer, and then it’s not curable," he states, underscoring the urgency of adapting screening strategies.
Bharat's research revealed that a staggering 65% of lung cancer patients at Northwestern didn't meet the criteria for screening based on the current guidelines. Notably, women, Asian Americans, and non-smokers diagnosed with lung cancer were disproportionately likely to be ineligible. (Another study published in the Journal of the American Medical Association found that even among those who are eligible for screening, less than 20% are actually up to date! And this is the part most people miss...)
Lung cancer remains the deadliest cancer in the United States, according to the ACS. However, death rates have been declining in recent decades, largely due to reductions in smoking. This progress, while encouraging, also highlights the growing proportion of lung cancer cases unrelated to smoking.
Dr. Helena Yu, a thoracic medical oncologist at Memorial Sloan Kettering Cancer Center, explains that as smoking-related lung cancer incidence decreases, the percentage of cases attributed to other factors increases. She notes that many of her lung cancer patients either quit smoking decades ago or were light smokers who wouldn't qualify for screening. "We probably should be screening a larger population because we’re finding it if you look at these different groups," she suggests.
The most perplexing cases, Dr. Yu notes, are those involving patients who have never smoked, like Kara Goodwin. "There aren’t clear environmental factors, we’re not seeing that it’s radon or secondhand smoke or anything specific that’s leading to these mutation-driven lung cancers," Yu said. "But there are probably factors that we don’t know in our modern-era world that are affecting both lung cancer but also other cancers, like GI cancers and other cancers that we’re seeing on the rise."
In Bharat's study, researchers modeled the potential impact of expanding screening criteria. They found that including individuals who smoked a pack a day for 10 years and were aged 40 to 85 could increase the detection rate to 62%. A universal approach, screening all adults in that age group regardless of smoking status, could potentially catch 94% of cancers.
"Having such a universal program would not only capture a majority of these patients, but we would be able to detect most of these patients at an earlier stage, which would dramatically improve the long-term survival as a whole population, with regards to lung cancer," Bharat asserts.
Consider Danielle Hoeg's story. This Chicago resident was diagnosed with lung cancer last year at the age of 43. She had never smoked. "I just didn’t believe it," Hoeg said. Her cancer was detected early – at stage 1 – during an unrelated MRI scan. She experienced no symptoms, such as a persistent cough or chest pain. Because of the early detection, she was able to undergo surgical removal of the tumor without needing additional treatment.
"I’m at the point now where I probably would, if I hadn’t found it, probably be dead by now," she said.
While MRIs are not the standard tool for lung cancer screening, the current method involves low-dose CT scans, a type of X-ray that uses low levels of radiation to create images of the lungs. A major concern with universal screening is the potential for unnecessary radiation exposure and false positives.
Dr. Jhanelle Gray, a thoracic medical oncologist at Moffitt Cancer Center in Tampa, Florida, emphasizes that "the screening guidelines, as they currently stand, are heavily focused on smoking history and age." This approach leaves out "some groups who don’t fit that criteria and are still at risk, and so when you look at the guidelines, we need to look at expanding the criteria to reach more high-risk patients." However, she acknowledges that "it’s kind of easier said than done," adding that "we also need the research to prove that this is a value."
Dr. Nicole Geissen, a thoracic surgeon at Rush University Medical Center in Chicago, advocates for prioritizing increased screening among individuals who currently qualify. "Yes, there needs to be ongoing discussions about making the criteria less stringent and more easily understood by both patients and primary care," Geissen said. "But until that happens, we need to really focus on, how do we get the other 80% of people that actually qualify for the current guidelines to get screened?"
Bharat is currently conducting a large clinical trial at Northwestern, enrolling adults and screening them for lung cancer. He hopes that the trial will identify the patient population that would benefit most from screening.
Dr. Yu points out a critical challenge: the lack of funding for lung cancer research. "Lung cancer is the No. 1 cancer killer, more than breast cancer, colon cancer, prostate cancer combined every year, but the funding for research is the lowest for lung cancer, and that’s partly because it’s survivors that are the biggest fundraisers," she said. "Unfortunately, most people don’t survive a diagnosis of lung cancer."
Marina Kopf is an associate producer with the NBC News Health and Medical Unit.
Maggie Vespa, NBC News Correspondent
This begs the question: Should lung cancer screening guidelines be expanded to include non-smokers and younger individuals, even with the potential risks of increased radiation exposure and false positives? What factors, beyond smoking history and age, should be considered when assessing lung cancer risk? Share your thoughts and opinions in the comments below. Do you agree with the current guidelines, or do you believe they need to be revised to save more lives? What are the potential downsides of universal screening, and how can they be mitigated? Join the conversation!
