Linking Mammograms and Lung Screening Saves Women’s Lives, Mount Auburn Hospital Study Shows

Study Finds Increased Lung Cancer Screening with Targeted Outreach

Cambridge, Mass. — Lung cancer kills more women each year than breast, cervical and ovarian cancer combined. Early detection can catch the disease early when it's most treatable, yet fewer than 20 percent of eligible people currently get screened.

A new study led by Mount Auburn Hospital pulmonologist Carey Conley Thomson, MD, MPH, in collaboration with colleagues at Vanderbilt University Medical Center, found a way to change that: reaching women where they already are — at their regular mammography appointments.

The CALM study (Coordinate a Lung Screening With Mammography), published in the Journal of the American College of Radiology, demonstrated that targeted outreach to women undergoing breast cancer screening significantly increased lung cancer screening rates. The American Cancer Society-funded study is the first multicenter initiative to show a statistically significant increase in lung screening enrollment among women through targeted outreach.

"Women who are already coming in for mammograms have often already overcome the biggest barriers to cancer screening — insurance, transportation, time off work," said Thomson, who is chair of the Department of Medicine at Mount Auburn Hospital, director of the hospital's Multidisciplinary Thoracic Oncology and Lung Cancer Screening Program, and the Charles S. Davidson associate professor of medicine at Harvard Medical School. "They're committed to preventive care. We just need to let them know they also qualify for lung screening."

Women at Risk Are Already Being Screened — for Something Else

Previous research found that 58 percent of women eligible for lung screening reported having a mammogram within two years, compared with only about eight percent who had undergone lung cancer screening. In other words, millions of women at high risk for lung cancer are already coming through the door for breast cancer screening. They just aren't being told they're also candidates for lung screening.

Women are also less likely than men to have had a conversation with their healthcare provider about lung screening, making mammography appointments a critical opportunity to close that gap.

The research team reviewed the records of more than 32,000 women who had mammograms at Mount Auburn Hospital and Vanderbilt University Medical Center between November 2019 and December 2022. Of those, 1,569 women (about five percent) were confirmed eligible for lung cancer screening based on age and smoking history. Nearly 70 percent of those eligible women had never been screened for lung cancer.

The two institutions used different approaches. At Mount Auburn, the pulmonary medicine team reviewed electronic health records for smoking history and contacted primary care physicians or the patients directly to inform them of their eligibility and offer enrollment in the lung screening program and to coordinate with their mammography appointments when possible. The team also surveyed women at mammography locations about their smoking history and interest in learning more about lung screening.

At Vanderbilt, the radiology department identified eligible patients before their scheduled mammography appointments and offered the opportunity to have both screenings on the same day at the same location.

Both approaches worked. Mount Auburn exceeded its target enrollment of 200 new patients, enrolling 214. Vanderbilt exceeded its target of 322, enrolling 445.

The results were clear: Baseline lung cancer screening scans in women increased significantly at both institutions during the study period. Notably, there was no corresponding increase in lung screening among men at either site, suggesting the gains were directly attributable to the mammography-based outreach, not simply expanded eligibility guidelines that took effect during the study.

A Model That Can Be Replicated

The study was designed to test whether the approach would work in different program structures. The success at both sites suggests the model is adaptable to a range of healthcare settings.

"Identifying women eligible for lung cancer screening through screening mammography programs is an opportunity to increase the uptake of lung cancer screening among individuals already committed to cancer screening," said Thomson, who also is chair of the American Cancer Society/National Lung Cancer Roundtable's Lung Cancer Early Detection Task Group.

Are You Eligible?

The United States Preventive Services Task Force recommends annual lung cancer screening with low-dose CT for adults ages 50 to 80 who have a 20 pack-year smoking history (for example, one pack a day for 20 years, or two packs a day for 10 years) and currently smoke or have quit within the past 15 years.

Mount Auburn Hospital is an American College of Radiology Designated Lung Cancer Screening Center. The hospital’s Lung Nodule Care Program provides individualized care plans for patients at risk for lung cancer, including screening, evaluation, diagnosis and treatment.

Women who think they may be eligible for lung cancer screening can call their primary care physician or Mount Auburn Hospital's pulmonary program at 617-354-8771 to schedule an appointment.

Co-authors included Chinmay Jani, MBBS; Padmanabh Shrikant Bhatt, MBBS, BSc; Giulia Paliotti, BSc; Alaaeldin Ahmed, MBBCh; Omar Al Omari, MBBS; Lipisha Agarwal, MBBS; Arashdeep Rupal, MBBS; Margaret Lotz, PhD; Susan E. Pories, MD; and Carey Conley Thomson, MD, MPH, of Mount Auburn Hospital and Harvard Medical School; Kim Lori Sandler, MD; Caroline M. Godfrey, MD, MPH; Valerie Welty, PhD; Stephen Deppen, MA, PhD; Alexis Bartley Paulson, MS; Shanna Joyner; Hannah Marmor, MD, MPH; Grace Wallace, CCRC; Lauren Hatcher, MD, MBA; Landon Fike, MD; and Arulita Gupta, MD, of Vanderbilt University Medical Center; Ella A. Kazerooni, MD, FCCP, of the University of Michigan; and Robert A. Smith, PhD, of the American Cancer Society.

This work was supported by grant funding from the American Cancer Society/National Lung Cancer Roundtable.

Thomson declares membership on the advisory board for Median Technology (lung nodules) and is an UpToDate author (asthma). The other Mount Auburn authors declare no conflicts of interest. For a complete list of declarations, please see the publication.

About Mount Auburn Hospital

Mount Auburn Hospital was founded in 1886. A teaching hospital of Harvard Medical School, its mission is to provide clinically excellent care with compassion and to teach students of medicine and the health professions.

Mount Auburn Hospital is a part of Beth Israel Lahey Health, a healthcare system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,700 physicians and 39,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.