· Executive Brief
Lung Cancer Awareness Month 2026
Move from recognition activity to a visible operating route with named owners and closed loops.
Leadership signal
Use Lung Cancer Awareness Month to examine the system behind the message.
Leaders can use this window to test whether public information, service entry points, internal referrals, and follow-up responsibilities form one understandable route. The review should start with the experience of people using the system and the teams responsible for receiving them.
Start by distinguishing what is known from what the organization still needs to learn. A campaign plan, communication volume, or meeting count does not establish that a route is usable. Leaders need direct listening, clear ownership, locally defined measures, and a method for keeping exceptions visible.
Executive opening
Lung cancer screening is a multi-year pathway, not a single scan
Lung Cancer Awareness Month arrives while most eligible adults in the United States remain unscreened. In a national survey analysis for 2024, overall lung cancer screening uptake was 22.7%.[3] The same study found 8.4 million adults who were up to date on breast or colorectal cancer screening and also eligible for lung screening.[3] Among them, lung screening use was only 28.7% in the breast screening group and 27.7% in the colorectal group.[3]
Those findings point to an operating problem rather than a messaging problem alone. Many of these adults already have a working relationship with a health system and complete other preventive tests. The gap sits in eligibility identification, ordering, scheduling and return, which are functions leaders own. The authors estimated that screening these adults would have raised national uptake from 22.7% to 70.5%.[3] Closing that gap depends on routine work done well, week after week.
Screening also does not end with a first scan. Across ten regional U.S. health systems, completion of the next lung screening round after a negative test was 56%.[13] The health system was the strongest predictor of repeat and consistent screening, with three- to ten-fold variation.[13] That finding places annual adherence within the reach of system design, not individual motivation alone.
This brief adds the evidence behind the operating route above. It covers uptake and annual return, shared decision-making, nodule follow-up, time to treatment, and racial and language equity. The aim is to help leaders choose where one accountable change will matter most during and after the month. Each section pairs published findings with the operating question they raise. Every figure carries its own population, setting and limits. Leaders should read the numbers as signals about where pathways leak, not as benchmarks for their own programs.
Current evidence
What the research says about uptake, adherence and eligibility
Low uptake is well documented, but the reasons differ by step. A Scottish pilot invited 2,801 people identified from primary care records, and the response rate was 23.8%.[5] Response varied from 17.8% to 38.1% across practices and was lower in more deprived areas.[5] Once people engaged, 436 of 503 eligible participants, or 86.7%, completed low-dose CT.[5] In that pilot, the hardest step was first contact rather than the scan itself. At the national level, 9.9% of women up to date on mammography and 11.8% of adults up to date on colorectal screening were eligible for lung screening.[3]
Screening also creates substantial work for downstream services. In the same pilot, lung nodules were detected in 25.7% of scans, with 11.8% requiring follow-up.[5] Coronary artery disease appeared in 56.4% of scanned participants and emphysema in 33%.[5] Programs that plan only for the scan will underestimate the radiology, pulmonary and primary care capacity that results require. The authors described a high burden of both malignant and non-malignant disease, much of it previously undiagnosed.[5]
Annual return is the second major leak. In a four-hospital Massachusetts system, 59.6% of 7,218 screened patients completed follow-up within 10 to 15 months, and 21.1% had no follow-up.[1] Only 26.5% completed all three follow-up scans within the recommended interval.[1] By contrast, an occupational program for 1,498 U.S. nuclear weapons workers achieved mean year-to-year adherence of 88.5% over a decade.[6] Labor unions co-sponsored that program in the communities it served.[6] In a ten-system U.S. consortium, 44% of lung screeners were consistent over three or more rounds, 42% inconsistent and 14% without repeat screening.[13]
Eligibility rules themselves shape who enters the pathway. In a large Southern U.S. cohort of 52,667 adults with a smoking history, most eligibility strategies identified fewer Black participants who later developed lung cancer than White participants.[15] Sensitivity was 0.46 to 0.73 for Black individuals versus 0.72 to 0.80 for White individuals.[15] Race-aware thresholds yielded the best balance of sensitivity and specificity and minimized inequities in the analysis.[15] Most existing strategies were developed using data predominantly from White populations.[15]
Prevention belongs inside the same pathway. A scoping review of 55 real-world screening program studies found that opt-out referral to embedded cessation programs showed consistently high uptake.[4] Yet sustained intervention delivery was reported in only 4% of those studies.[4] Implementation most often involved low-intensity behavioral interventions.[4] More intensive group or multicomponent interventions showed relatively high cessation outcomes.[4]
Figure 1
Annual return to lung cancer screening varies widely by setting and definition
Percent of screened people completing the next or all follow-up screens, as defined in each study. Values are copied from the cited studies [1], [6], [12], [13]; none is estimated.
Data note. These values come from different studies, populations, years and adherence definitions, so this is an indirect comparison; the bars show how much annual return depends on setting and definition, not how one program ranks against another.
Limitation. Each value uses its own denominator and time window; the occupational cohort is a sponsored program and the consortium figure follows a negative index test only.
Figure data (5 rows)
| Measure | Value | Population, setting and year as reported | Source |
|---|---|---|---|
| Completed all three follow-up scans on time | 26.5% | 7,218 patients in a four-hospital Massachusetts health system, initial screens 2015 to 2025 | [1] |
| Low-dose CT follow-up within 15 months | 35.6% | LDCT-only adherence in a New York health system cohort of 13,773 patients, 2016 to 2023 | [12] |
| Completed next screening round | 56% | 6,209 lung screeners after a negative index test in ten regional U.S. health systems, 2010 to 2019 | [13] |
| Completed follow-up within 10 to 15 months | 59.6% | First follow-up after the initial screen, same Massachusetts cohort | [1] |
| Mean year-to-year on-time adherence | 88.5% | 1,498 U.S. nuclear weapons workers in a union co-sponsored program, 2014 to 2024 | [6] |
Continuum of care
Where the pathway breaks between scan, nodule and treatment
The lung cancer continuum runs from eligibility through annual return, nodule surveillance, diagnosis and treatment. Each step crosses at least one boundary among primary care, radiology, pulmonary medicine, thoracic surgery and oncology. The evidence shows that delays and drop-offs tend to cluster at those boundaries. When one service completes its step, the next service may not know a patient is waiting.
Nodule follow-up can be reliable when it is designed as a tracked obligation. In the occupational screening program, all nodules suspicious for lung cancer received follow-up.[6] In the same program, 90.4% of three- and six-month follow-up scans for indeterminate nodules were completed within 11 months.[6] Advanced age, non-White race and Midwest or Western residence were associated with lower annual adherence.[6] Leaders should ask whether every nodule result produces a dated follow-up order and a named tracking owner.
After diagnosis, time to treatment is not equal across patients. Among 10,734 Ontario patients with stage I non-small cell lung cancer, older age, more comorbidities, lowest neighborhood income and distance from a cancer center were associated with longer time to treatment.[9] For leaders, early-stage disease is the window in which the interval from diagnosis to first treatment deserves its own owner and its own clock.
Distance from a cancer center adds to that risk for networks that diagnose in one place and treat in another. A referral that moves between organizations needs an accepting owner, a scheduled first visit and a visible clock. Without those elements, each handoff can add days that no single department sees. Leaders can make that clock visible by tracking each referral from diagnosis to first treatment, including referrals that leave the network.
Measurement choices also determine whether leaders notice a break. Among 13,773 patients in a New York health system, adherence counted as low-dose CT within 15 months was 35.6%.[12] When any follow-up chest CT with no time limit counted, adherence rose to 68.4%.[12] The same program can look weak or strong depending on the definition, so the definition must be fixed before results are reviewed. Across the ten-system consortium, adherence was suboptimal and declined as the number of testing rounds increased.[13] Counting any follow-up chest CT raised adherence to 45.8% at 15 months and 59.2% at 24 months.[12]
Figure 3
Why the pathway breaks
People
- Primary care clinicians with limited confidence in screening and shared decision-making
- Limited language-concordant coaching and navigation capacity
- Fear, fatalism and low awareness of screening and eligibility
Process
- Annual scans that require a new primary care visit before ordering
- Cessation offered by separate referral rather than by default
- Referrals between diagnosing and treating facilities without an accepting owner
Technology
- Smoking history and pack-years missing or unused for outreach
- No shared tracking of annual return and nodule surveillance
- Reminders that are excessive or inconsistent with other system messages
Environment
- Lower response in more deprived areas
- Geographic variation in adherence
- Communities with limited prior exposure to screening information
Policy
- Eligibility criteria that identify fewer Black adults who develop lung cancer
- Payer and referral rules that add steps before treatment
- Few sustained program-level supports for cessation
Measurement
- Adherence definitions that change results by time frame and imaging type
- Results not stratified by race, language or insurance
- Time to treatment not tracked across facilities
Unranked qualitative cause-and-effect diagram for the outcome in the box: Eligible adults are not screened, do not return annually, or wait too long between abnormal findings and treatment Causes are assembled from the cited literature [1], [2], [3], [4], [5], [7], [8], [9], [10], [12], [14], [15]; categories are not weighted and their order carries no meaning.
Data note. Qualitative; no frequencies are implied.
Limitation. Causes drawn from published studies may not all apply locally; validate them with frontline teams.
Figure data (6 rows)
| Category | Causes drawn from the cited literature |
|---|---|
| People | Primary care clinicians with limited confidence in screening and shared decision-making; Limited language-concordant coaching and navigation capacity; Fear, fatalism and low awareness of screening and eligibility |
| Process | Annual scans that require a new primary care visit before ordering; Cessation offered by separate referral rather than by default; Referrals between diagnosing and treating facilities without an accepting owner |
| Technology | Smoking history and pack-years missing or unused for outreach; No shared tracking of annual return and nodule surveillance; Reminders that are excessive or inconsistent with other system messages |
| Environment | Lower response in more deprived areas; Geographic variation in adherence; Communities with limited prior exposure to screening information |
| Policy | Eligibility criteria that identify fewer Black adults who develop lung cancer; Payer and referral rules that add steps before treatment; Few sustained program-level supports for cessation |
| Measurement | Adherence definitions that change results by time frame and imaging type; Results not stratified by race, language or insurance; Time to treatment not tracked across facilities |
Access
Making the first scan and the annual return easy to reach
Access in lung screening starts with finding eligible people, many of whom already use the health system. The Scottish pilot showed that recruiting people through smoking history recorded in primary care records is feasible.[5] Because uptake was modest and socially patterned, the authors called for repeated invitations and targeted engagement.[5] Non-responders were more likely to be current smokers, at 69.3% versus 49.8% of responders.[5] Of 608 people assessed for eligibility, 503 met at least one predefined high-risk criterion.[5]
Existing preventive care offers a ready entry route. Adults already up to date on mammography or colorectal screening form a large group engaged in prevention yet often unscreened for lung cancer.[3] Linking eligibility checks to those visits and outreach lists is an operating choice, not a new program. It uses contacts the system already makes. By the study estimate, screening these adults would increase national uptake about three-fold.[3] A program can test whether one eligibility check at a mammography or colonoscopy visit produces a completed order.
Reducing steps helps the annual return. One pragmatic trial tested an educational video on timely return and outreach reminders after a scan was ordered.[2] In an integrated health system in Washington State, patients strongly endorsed outreach reminders to schedule annual screening after their clinician ordered a scan without an appointment.[2] Most participants endorsed an annual scan ordered without a primary care visit.[2] Those already screening did not feel they needed to see their clinician one year later to repeat it.[2] Patients also named barriers, including content that felt familiar and missing information for specific needs.[2]
The same patients preferred reminders delivered in more than one format, but excessive reminders were a barrier.[2] Reminders were acceptable when they mirrored other health system communications.[2] Access design therefore depends on coordination among scheduling, imaging and patient communication teams.
Default design matters for prevention services too. Opt-out referral to embedded cessation programs showed consistently high uptake in real-world screening programs.[4] The review authors noted that many screening programs globally still have not implemented formal cessation supports.[4] Embedding cessation in the screening visit removes a separate appointment for people who smoke. Opt-out design shifts the default from asking people to seek help to offering help unless they decline.
Executive guidance · System route
Connect the month to an accountable system route.
Use this route as a discussion framework. Replace each stage with the organization’s approved process, qualified roles, current service capacity, and applicable requirements. Do not infer a clinical protocol from the observance title.
The route at a glance
- Listen
- Clarify entry
- Navigate across services
- Protect transitions
- Verify and learn
Reliability rule: Every stage needs a named owner, an observable status, an approved escalation path, and a defined signal that shows whether responsibility moved or remained unresolved.
Listen
Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions.
Clarify entry
Publish a plain-language first step and identify who receives requests through each approved channel.
Navigate across services
Make the receiving service, required information, current status, and next accountable owner visible whenever the route crosses an organizational boundary.
Protect transitions
Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations.
Verify and learn
Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals.
Figure 2
The system route as one flow
The five stages of the system route described in this brief, drawn as one flow with a learning loop back to the start. The stages are the page’s original executive guidance, not a clinical protocol.
Data note. Shows sequence and handoffs only; it carries no counts or rates.
Limitation. Local processes may add, merge or reorder stages under organizational policy.
Figure data (5 rows)
| Stage | What the stage requires |
|---|---|
| Listen | Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions. |
| Clarify entry | Publish a plain-language first step and identify who receives requests through each approved channel. |
| Navigate across services | Make the receiving service, required information, current status, and next accountable owner visible whenever the route crosses an organizational boundary. |
| Protect transitions | Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations. |
| Verify and learn | Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals. |
Equity and trust
Equity gaps appear at eligibility, annual return and treatment
Racial inequity in lung screening begins before anyone is offered a scan. In a Southern U.S. cohort, only 47.4% of Black patients with lung cancer aged 50 to 54 would have qualified under the 2021 screening criteria, versus 80.3% of White patients.[14] Eligibility gaps like this separate two questions leaders should track: who qualifies under current criteria, and who among those who qualify actually reaches a scan.
Eligibility criteria can also carry algorithmic bias.[15] In the Southern cohort, removing race or using uniform risk thresholds did not resolve racial eligibility disparities.[15] Replacing pack-years with smoking duration improved equity but raised the false-positive rate to 0.71 for Black persons versus 0.61 for White persons.[15] Race-aware thresholds reached sensitivity of 0.71 to 0.73 for Black persons versus 0.72 to 0.74 for White persons.[15] Leaders who adopt eligibility tools should ask how those tools perform across the populations they serve.
Language is a measurable driver of annual return. Non-English speakers were less likely than English speakers to complete timely screening at every round, including 51.4% versus 60.2% at the first follow-up.[1] Non-English language preference was associated with 21% lower odds of timely annual screening after adjustment.[1] The authors described linguistically tailored outreach, patient education and navigation support as critical.[1] Non-English speakers were also more likely to have no follow-up at each interval.[1]
Trust and cultural fit shape participation. Focus groups with 19 Hispanic adults identified limited awareness of screening, a preference for clear and friendly communication, fear and fatalism, and the importance of culturally relevant design.[7] Of those participants, 68.4% primarily spoke Spanish.[7] Intervention research has not yet caught up, since 74% of screening intervention studies in one review included majority White samples.[11] Participants had a mean smoking history of 30.6 pack-years, and 57.8% were from South America.[7]
Equity review should not stop at diagnosis. In Ontario, patients in the lowest neighborhood income quintile had significantly longer time to stage I treatment than those in higher quintiles.[9] That is a reason for programs to examine their own intervals by patient group rather than assume they are uniform. Equity review should therefore follow the whole route, not only the screening rate. Stratifying time to treatment by race and payer is a practical first step for any cancer program.
Human infrastructure
The clinicians, navigators and coordinators who keep screening on track
Primary care clinicians identify eligible patients, start shared decision-making and coordinate follow-up care.[8] Yet many report limited knowledge and confidence in implementing lung screening.[8] At a safety-net hospital in Central Indiana, a 30-minute curriculum co-developed with screening experts increased clinicians’ comfort discussing screening and results.[8] Referrals of eligible patients to the screening program also increased after the curriculum.[8] The authors proposed expanding the curriculum beyond a single clinic and converting it into interactive, mobile-friendly modules.[8] The curriculum also improved how clinicians applied screening criteria to patient scenarios.[8]
Shared decision-making is a workforce task that requires time, skill and language capacity. One model under cultural adaptation pairs telehealth decision coaching with navigation in primary care.[7] Hispanic adults in the related focus groups preferred clear and friendly communication.[7] Coaches and navigators need training and protected time to deliver it consistently. Moving part of that conversation to trained coaches can relieve primary care visits while keeping the decision informed. That design choice still needs local testing before scale.
Implementation evidence remains thin on the program conditions staff depend on. In the cessation review, provider readiness to adopt was reported in 7% of studies and time and cost in 5%.[4] A separate scoping review of 23 screening intervention studies found that all targeted individual-level outcomes.[11] Only 26% used a behavioral theory, and decision aids, educational videos and tailored outreach were the most common strategies.[11] The review authors urged future work to test implementation strategies and to prioritize racial and ethnic minority groups.[11]
Coordination roles carry the annual cycle. The occupational program reached mean year-to-year adherence of 88.5% across up to eight annual scans offered over a decade.[6] Nearly one-third of participants, 30.8%, completed every scan on time.[6] That result came from a defined cohort with organized sponsorship, so it shows what is achievable rather than what is typical.[6]
Workforce planning should count the full screening cohort each year, not only new enrollees. Every returning patient, nodule surveillance scan and incidental finding adds work for coordinators, radiologists and primary care teams. Leaders should match navigation staffing to that cumulative volume and review it as the program grows. Staffing reviews should include interpreter and scheduling support, since those roles shape whether patients return.
Executive guidance · Operating dashboard
Review reliability, not campaign activity alone.
Do not publish a number until the organization defines its numerator, denominator where relevant, owner, source system, exclusions, review cadence, and limits. The candidates below are management prompts, not benchmarks or reported results.
Four operating signals
Each signal pairs an executive question with one candidate local measure, set out below.
Executive guidance · Signal
Entry-point clarity
Can people and staff identify the approved first step without searching across conflicting instructions?
- Candidate local measure
- Locally defined contact, routing, and repeat-contact signals by channel and service.
Executive guidance · Signal
Ownership reliability
Does a specific team accept each request and make its status visible?
- Candidate local measure
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
Executive guidance · Signal
Navigation continuity
Where does ownership become unclear as people move among information, evaluation, services, and follow-through?
- Candidate local measure
- Locally defined unaccepted handoffs, repeated contacts, missing information, unresolved routes, and navigation feedback.
Executive guidance · Signal
Improvement closure
Does the organization correct recurring friction and report what changed?
- Candidate local measure
- Selected barriers, assigned actions, completion status, and post-change review.
Figure 4
The operating system behind the dashboard
The four operating signals from this brief’s dashboard, each tied to the candidate owner named in the executive scorecard, around one accountable route. Drawn from the page’s original executive guidance.
Data note. Structural diagram; no measured values.
Limitation. Owners are candidates to be confirmed locally.
Figure data (4 rows)
| Operating signal | Candidate owner |
|---|---|
| Entry-point clarity | Executive sponsor and operational lead |
| Ownership reliability | Operational owner and participating teams |
| Navigation continuity | Sending and receiving owners |
| Improvement closure | Improvement owner and executive sponsor |
Executive guidance · Handoff workflow
Transfer responsibility with acknowledgment and visibility.
A handoff is reliable only when the sending party knows who is expected to receive the work, the receiving party acknowledges responsibility, and any unresolved exception remains visible. Local policy and qualified judgment control the actual process.
How responsibility moves
Lane A
From message to accepted ownership
- Confirm the approved message and intended audience.
- Publish the actual entry point and receiving role.
- Acknowledge receipt using the locally approved method.
- Escalate when ownership or response remains unclear.
Lane B
From accepted ownership to verified follow-through
- Record the next accountable owner and visible status.
- Name the receiving service and confirm acceptance without promising a clinical determination or outcome.
- Keep unresolved work visible across boundaries.
- Confirm closure or document the continuing exception.
Executive guidance · Executive scorecard
Connect operating signals to accountable executive review.
The scorecard keeps review focused on decisions. Leaders should set definitions locally, examine variation without overclaiming cause, and pair quantitative signals with the experience of people who use and operate the route.
Who reviews what
- Executive sponsor and operational lead
- Operational owner and participating teams
- Sending and receiving owners
- Improvement owner and executive sponsor
Candidate owners named in the scorecard, confirmed locally.
| Operating signal | Executive question | Candidate owner | Suggested review point |
|---|---|---|---|
| Entry-point clarity | Can people and staff identify the approved first step without searching across conflicting instructions? | Executive sponsor and operational lead | At campaign launch and close |
| Ownership reliability | Does a specific team accept each request and make its status visible? | Operational owner and participating teams | At a locally defined cadence |
| Navigation continuity | Where does ownership become unclear as people move among information, evaluation, services, and follow-through? | Sending and receiving owners | At a locally defined cadence |
| Improvement closure | Does the organization correct recurring friction and report what changed? | Improvement owner and executive sponsor | Until action is verified |
Figure 5
Control points for a reliable lung cancer screening and diagnostic pathway
| Control point | Risk if missing | Owner | Evidence of control |
|---|---|---|---|
| Eligibility identification linked to existing preventive care | Eligible adults already in the system are never offered screening | Ambulatory quality lead and screening program director | Share of eligible adults up to date on other cancer screening who have a lung screening order |
| Annual scan ordered and scheduled with reminders | Patients drop out after the first scan | Screening program director and scheduling lead | Next-round completion within the locally defined interval |
| Tracked nodule surveillance | Indeterminate nodules miss their follow-up scan | Radiology lead and nodule program coordinator | Share of surveillance scans completed within the planned window |
| Accepted referral between diagnosing and treating facilities | Days are added at the handoff with no visible owner | Thoracic oncology service line leader | Time from diagnosis to treatment start, including cross-facility referrals |
| Language-concordant outreach and navigation | Non-English speakers return less often at every round | Patient access and interpreter services leaders | Annual adherence stratified by preferred language |
| Default cessation offer within screening | People who smoke never reach cessation support | Tobacco treatment program lead | Share of screened people who smoke offered cessation at the visit |
| Fixed adherence and timeliness definitions for board review | Results look better or worse depending on the definition used | Chief quality officer and board quality committee | Documented definitions and results reported by race, language and insurance |
Control points derived from the cited evidence [1], [2], [3], [4], [6], [9], [12], [13] and this brief’s executive guidance.
Data note. Each row is a control to verify, not a measured result.
Limitation. Owners and evidence of control must follow local policy and applicable requirements.
Public communication
Communicating screening in ways that earn informed participation
Awareness remains a real barrier in some communities. In a pilot with 40 eligible Latino adults who had not completed annual screening, 65% had never heard of lung cancer screening.[10] In addition, 72.5% were unaware of their own eligibility.[10] Campaign messages that assume people know the test exists will miss many of the people who most need it. Among participants, 57.5% preferred Spanish and 52.5% had a high school education or less.[10] Of the 40 participants, 35 completed the three-month assessment.[10]
Text messaging in English and Spanish, co-developed with a community advisory board, was acceptable in that pilot.[10] The record-verified screening rate after three months was 25%, and 32.5% completed shared decision-making.[10] Of respondents, 90.9% were satisfied and all said they would recommend the program to a friend or family member.[10] As a single-arm pilot, the study cannot establish effectiveness, and the authors called for a randomized trial.[10]
Message design should match where a person is in the screening cycle. First-time screeners found an educational video helpful and comforting.[2] People already screening annually felt the same video lacked new information.[2] Communication that acknowledges fear and explains next steps plainly also responds to themes Hispanic adults raised in focus groups.[7] Communication that respects what people already know keeps reminders welcome rather than intrusive.
Communication includes how leaders describe performance. Across ten health systems, lung screeners over the next two rounds were 47% consistent, 31% inconsistent and 22% without repeat screening.[13] Because adherence rates shift with time frame and imaging type, the New York authors proposed standardized definitions and a four-category adherence schema.[12] Public and board reports should name the definition behind every adherence figure. In the same consortium, next-round completion was 62% for colorectal and 56% for cervical screening, so lung screening faces a shared problem.[13]
Plain reporting builds trust inside the organization as well. When teams see the same definitions, they can compare results across sites without debating the numbers. That shared language makes it easier to celebrate progress honestly during the month and to sustain attention afterward. It also helps staff explain to patients why the next scan matters and when it is due. Messages that name the next step and its expected timing support the annual cycle.
Executive guidance · 90-day plan
Use 90 days to correct one visible operating barrier.
The time boxes below are a management framework, not a clinical timeline. Adjust them to risk, scope, governance, resources, stakeholder participation, and applicable review requirements.
Ninety days, three moves
- Days 1–30See the current route
- Days 31–60Build the reliable path
- Days 61–90Make the change visible
Days 1–30 · Listen and map
See the current route
- Name an executive sponsor and an operational owner.
- Listen to people using the route and representative frontline teams.
- Map how Lung Cancer Awareness Month communications connect to real entry points, owners, transitions, and escalation.
- Select one recurring barrier that the organization can responsibly address.
Days 31–60 · Design and test
Build the reliable path
- Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal.
- Validate the design with every sending and receiving team involved.
- Test one cross-service navigation handoff and correct the point where status or ownership becomes unclear.
- Test the route in more than one representative setting or operating period where practical.
Days 61–90 · Implement and verify
Make the change visible
- Launch the redesigned route with a small set of locally defined measures.
- Review unresolved work and recurring friction using a learning approach.
- Correct implementation barriers and record who owns each remaining dependency.
- Report what changed, what evidence was reviewed, and what still requires live oversight.
Figure 6
The 90-day plan on one timeline
The 90-day plan from this brief drawn as a timeline: each action sits in the 30-day window the plan assigns it. The full wording of each action is in the figure data and in the plan above.
Data note. Time boxes are a management framework, not a clinical timeline.
Limitation. Durations are uniform 30-day windows; real tasks may span windows.
Figure data (12 rows)
| Window | Action |
|---|---|
| Days 1–30 · Listen and map | Name an executive sponsor and an operational owner. |
| Days 1–30 · Listen and map | Listen to people using the route and representative frontline teams. |
| Days 1–30 · Listen and map | Map how Lung Cancer Awareness Month communications connect to real entry points, owners, transitions, and escalation. |
| Days 1–30 · Listen and map | Select one recurring barrier that the organization can responsibly address. |
| Days 31–60 · Design and test | Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal. |
| Days 31–60 · Design and test | Validate the design with every sending and receiving team involved. |
| Days 31–60 · Design and test | Test one cross-service navigation handoff and correct the point where status or ownership becomes unclear. |
| Days 31–60 · Design and test | Test the route in more than one representative setting or operating period where practical. |
| Days 61–90 · Implement and verify | Launch the redesigned route with a small set of locally defined measures. |
| Days 61–90 · Implement and verify | Review unresolved work and recurring friction using a learning approach. |
| Days 61–90 · Implement and verify | Correct implementation barriers and record who owns each remaining dependency. |
| Days 61–90 · Implement and verify | Report what changed, what evidence was reviewed, and what still requires live oversight. |
Executive guidance · Leadership close
Pair recognition with a system people can trust.
Recognition matters. It becomes durable when leaders also listen, clarify the route, support the people operating it, close an identified gap, and report the result without claiming more than the evidence supports.
Leadership commitment
Connect the message to one usable, measured, and sustained operating change.
Executive action kit · Month observance
Turn Lung Cancer Awareness Month into accountable action.
Move from recognition activity to a visible operating route with named owners and closed loops.
Leadership focus
Use this observance to examine navigation, longitudinal ownership, and specialty-care coordination. Select one verified barrier, assign an accountable owner, and carry the improvement beyond the campaign window.
Workforce lens
Ask whether staffing, role clarity, training, tools, workload, and escalation support the people operating the information, diagnostic navigation, support, and follow-through pathway.
Patient and community lens
Make the approved first step clear. Test whether a person can move from information to an acknowledged next action without navigating conflicting instructions.
Equity and access lens
Review whether language, transportation, cost, digital access, disability, geography, or trust changes a person’s ability to complete the locally approved route.
Five-minute briefing
Inspect the operating sequence
Listen with people using the pathway, caregivers, navigation teams, clinical services, and community partners. Find one a confusing entry point, unowned transition, or unresolved navigation need, then test the locally approved route from entry through acknowledged follow-through.
- Listen
- Clarify entry
- Navigate across services
- Protect transitions
- Verify and learn
Leadership actions for this week
- Name an executive sponsor and frontline operating owner.
- Ask people using and operating the pathway where ownership becomes unclear.
- Test one representative route from first question to acknowledged next step.
- Select one barrier that can be corrected without overstating the evidence.
- Set a review date and define how completion will be verified.
Candidate measures
Define every numerator, denominator where relevant, owner, data source, exclusions, cadence, and limitation locally. These are management prompts, not external benchmarks.
- Locally defined contact, routing, and repeat-contact signals by channel and service.
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
- Locally defined unaccepted handoffs, repeated contacts, missing information, unresolved routes, and navigation feedback.
Department readiness checklist
- The public and staff entry points match the actual approved process.
- A specific role accepts each request, referral, or escalation.
- Handoffs include acknowledgment and a visible unresolved state.
- Language, disability, digital, transportation, and trust barriers receive explicit review.
- Communications do not introduce unsupported themes, statistics, or clinical advice.
- A named leader will review what changed after the observance.
Intended audiences
- Executive and Operational Leaders
- Patient Experience and Access Leaders
Staff communication template
During Lung Cancer Awareness Month, our organization will connect awareness with a practical review of the information, diagnostic navigation, support, and follow-through pathway. Use approved information, identify the correct entry point, confirm ownership when work moves, protect privacy, and escalate unresolved barriers through local channels.
Community communication template
Lung Cancer Awareness Month is an opportunity to share trustworthy information and make the next step easier to find. Use our approved channels for information and support. If a request changes hands, our goal is to keep ownership and follow-through visible.
Measurement worksheet
- Signal
- What observable condition will show whether the route works?
- Definition
- What is included, excluded, and counted?
- Owner
- Who reviews the signal and acts on exceptions?
- Cadence
- When will leaders review it?
- Equity check
- Which differences require protected, locally appropriate review?
- Closure
- What evidence will confirm the improvement was completed?
- Editorial review
- Completed
- Source records
- 2 listed under Authoritative resources
- Review standard
- Sourced facts remain separated from original executive guidance
- Clinical boundary
- No new statistical or clinical claim was added by this action kit
Sources and content boundary
Authoritative resources
Use note: All operating models, measures, scorecard questions, and action steps are original executive guidance. This article supports leadership planning and education. It does not replace clinical judgment, emergency procedures, legal advice, professional standards, organizational policy, or applicable federal, state, and local requirements.
Peer-reviewed references
References
Fifteen peer-reviewed sources, newest first. Each was individually verified through authenticated academic research databases. Bracketed numbers in the text link here; the original executive guidance on this page carries no citations because it is guidance, not a sourced claim. Sources last checked in those databases on .
- 1.Núñez ER, Priya A, Shankar V, Ganim R, Benjamin LN, Diamond LC, et al. Language Preference Associated with Disparities in Annual Lung Cancer Screening Adherence in an Integrated Healthcare System. Annals of the American Thoracic Society. 2026:aaoag260. https://doi.org/10.1093/annalsats/aaoag260
- 2.Palazzo L, Luce C, Vasavada A, Mettert K, Gao H, Ralston JD, et al. I need it. Without it, I wouldn’t have gone, and I do want to go: patient perspectives on the acceptability and appropriateness of two patient-centered interventions to improve adherence to annual lung cancer screening. Frontiers in Health Services. 2026;6:1810956. https://doi.org/10.3389/frhs.2026.1810956
- 3.Potter AL, Kothagundla S, Guo Q, Cheney B, Senthil P, Srinivasan D, et al. Millions of adults undergoing breast and colorectal cancer screening are eligible for lung cancer screening, but do not get screened. JNCI: Journal of the National Cancer Institute. 2026:djag176. https://doi.org/10.1093/jnci/djag176
- 4.Harrison NJ, Rankin NM, Paul CL, Bowden JA, Bendotti H, Roseleur J, et al. Implementation of smoking cessation interventions in real-world lung cancer screening: a RE-AIM–guided scoping review. JNCI: Journal of the National Cancer Institute. 2026:djag102. https://doi.org/10.1093/jnci/djag102
- 5.Cavers D, Akram AR, Sage EK, Maclay JD, Cowell GW, Mitchell J, et al. Pilot feasibility study to deliver low-dose CT lung cancer screening in Scotland: descriptive findings from the LungScot study. BMJ Open. 2026;16(9):e120569. https://doi.org/10.1136/bmjopen-2026-120569
- 6.Markowitz SB, Liu B, Miller A, Taioli E, Stuckey J, Miller JA, et al. High Adherence Over a Decade of Annual Lung Cancer Screening in an Occupational Cohort. Clinical Lung Cancer. 2026;27(6):1-10. https://doi.org/10.1016/j.cllc.2026.05.002
- 7.Arana-Chicas E, Reyes AV, Chavez-Iniguez A, Macenat M, Ferrante J, Capurro C, et al. Informing the cultural adaptation of a lung cancer screening shared decision-making and navigation intervention for Hispanic adults: a qualitative study. Cancer Causes & Control. 2026;37(10):166. https://doi.org/10.1007/s10552-026-02257-7
- 8.Duncan FC, Carrasco AJ, Carter A, Pietrandrea M, Jackson EJ, Sears CR. Improving lung cancer screening in real-world settings: a pragmatic approach to provider education, barriers, and solutions. Frontiers in Oncology. 2026;16:1750327. https://doi.org/10.3389/fonc.2026.1750327
- 9.Hanna NM, Shakeel S, Akhtar-Danesh GG, Finley C, Akhtar-Danesh N. A population-based study on the impact of social determinants of health on time to treatment of stage I lung cancer in Ontario, Canada. BMC Cancer. 2026;26(1). https://doi.org/10.1186/s12885-026-15875-w
- 10.Ramos-Santiago JW, Orfin RH, Evans MJ, Sutton MD, Barria López F, Chávez-Iñiguez A, et al. Feasibility, acceptability, and preliminary impact of a text messaging intervention to increase the uptake of lung cancer screening among Latinos: single-arm pilot study. Journal of Thoracic Disease. 2026;18(7):727-727. https://doi.org/10.21037/jtd-2026-1205
- 11.Anderson SL, McBride CM. The current scope of lung cancer screening interventions being implemented globally. Cancer Epidemiology. 2026;105:103240. https://doi.org/10.1016/j.canep.2026.103240
- 12.Bade BC, Gandomi A, Hasan E, Haramati L, Raoof S, Makhnevich A, et al. Toward Redefining Adherence: The Impact of Adherence Definition on Lung Cancer Screening Program Benchmarks. Journal of the American College of Radiology. 2026;23(4):565-572. https://doi.org/10.1016/j.jacr.2025.11.025
- 13.Halm EA, Del Vecchio NJ, Rendle KA, Tiro JA, Zheng Y, Winer RL, et al. Longitudinal Adherence to Screening for Colorectal, Cervical, and Lung Cancer in a US Consortium. Journal of General Internal Medicine. 2025;41(7):1761-1770. https://doi.org/10.1007/s11606-025-09835-6
- 14.Potter AL, Kuhan S, Senthil P, Mansur A, Haridas C, Srinivasan D, et al. The 2021 US Preventive Services Task Force lung cancer screening eligibility criteria disproportionately exclude younger Black patients with lung cancer. Cancer. 2025;131(1):1-10. https://doi.org/10.1002/cncr.35676
- 15.Manful A, Mercaldo S, Blume JD, Aldrich MC. Addressing algorithmic bias in lung cancer screening eligibility. JNCI: Journal of the National Cancer Institute. 2025;118(2):343-353. https://doi.org/10.1093/jnci/djaf298
Claim-to-source matrix
What each source supports
Every sourced claim in the new sections maps to the references that support it, the section where it is used, and the limitation a reader should keep in mind. Original executive guidance carries no sources because it is guidance, not a finding.
| Claim group | Sources | Years | Used in | Limitation |
|---|---|---|---|---|
| National screening uptake and eligible adults already engaged in other cancer screening | [3] | 2026 | Executive opening | Self-reported national survey data for 2024; uptake projection assumes every eligible adult up to date on breast or colorectal screening is screened. |
| Repeat and consistent screening across health systems and the role of the system | [13] | 2025 | Executive opening | Retrospective cohort of 6,209 lung screeners in ten regional U.S. health systems, 2010 to 2019; follows a negative index test only. |
| Invitation response, scan completion, nodules and incidental findings in a population pilot | [5] | 2026 | Current evidence | Descriptive Scottish pilot with a one-off scan; response measured among invited people identified from primary care records. |
| Annual adherence and language preference in a regional health system | [1] | 2026 | Equity and trust | Single four-hospital Massachusetts system; retrospective cohort with censoring of Lung-RADS 3 or 4 results. |
| Long-term annual adherence and nodule follow-up in an occupational cohort | [6] | 2026 | Continuum of care | Union co-sponsored program for nuclear weapons workers; results may not generalize to general clinical populations. |
| Social determinants of time to treatment for stage I non-small cell lung cancer | [9] | 2026 | Continuum of care | Population-based retrospective cohort from linked administrative data in Ontario, Canada; findings may not transfer to U.S. payer settings. |
| Effect of adherence definitions on program benchmarks | [12] [13] | 2026, 2025 | Public communication | Single New York health system for the definition analysis; consortium data use guideline intervals that differ from local definitions. |
| Racial inequity and algorithmic bias in screening eligibility | [14] [15] | 2025 | Equity and trust | Both analyses draw on Southern U.S. cohort data from a predominantly Black population; eligibility was modeled, not observed in practice. |
| Cultural fit, awareness and text messaging for Hispanic and Latino adults | [7] [10] | 2026 | Public communication | Small qualitative sample of 19 and single-arm pilot of 40; neither establishes effectiveness. |
| Patient acceptance of reminders, video and ordering without a visit | [2] | 2026 | Access | Qualitative interviews with 32 members of one integrated health system. |
| Clinician education, cessation integration and intervention research gaps | [4] [8] [11] | 2026 | Human infrastructure | Single safety-net site for the curriculum; scoping reviews describe reporting patterns rather than pooled effects. |
About the author
Greg Wahlstrom
MBAHCM
President and Chief Executive Officer, The Healthcare Executive
View Greg’s profile©2014 – 2026 The Healthcare Executive. All rights reserved.