From Screening to Strategy: Navigating the First Steps in Lung Cancer Care

A panel of multidisciplinary experts convened to discuss optimizing perioperative and neoadjuvant immunotherapy strategies and resectable non–small cell lung cancer, with a focus on recent data from the 2025 American Society of Clinical Oncology Annual Meeting.

Moderated by Ticiana Leal, MD, of the Emory University School of Medicine, the roundtable featured perspectives from Mara Antonoff, MD, FACS, of the University of Texas MD Anderson Cancer Center, Robert E. Merritt, MD, MBA, FACS, of The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, and Coral Olazagasti, MD, of the Sylvester Comprehensive Cancer Center and University of Miami Miller School of Medicine.

In the first segment of this roundtable series, the panel discusses challenges and considerations surrounding lung cancer screening, how teams address a positive lung cancer screening result, and how they communicate with patients about the results and next steps.

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Dr. Leal: Hello everyone. Thank you for joining us today for this Lung Cancers Today roundtable. We’ll be talking about optimizing perioperative and neoadjuvant immunotherapy strategies and resectable non–small cell lung cancer. I’m Dr. Ticiana Leal. I’m a medical thoracic oncologist, associate professor, and director of the thoracic program at the Emory University School of Medicine in Atlanta, Georgia. I’m joined here by esteemed colleagues and panelists. I’ll let them introduce themselves. I’ll start with Dr. Antonoff.

Dr. Antonoff: My name is Mara Antonoff. I’m an associate professor of thoracic and cardiovascular surgery at MD Anderson Cancer Center in Houston, Texas. Thank you so much for having me here today.

Dr. Leal: Excellent. Dr. Merritt?

Dr. Merritt: I’m Robert Merritt. I’m a thoracic surgeon at Ohio State and the James Cancer Center. I’m the director of Thoracic Surgery. Thank you for the invitation to be a part of the panel today.

Dr. Leal: Excellent. And Dr. Olazagasti?

Dr. Olazagasti: Hi. My name is Coral Olazagasti, and I’m an assistant professor at the University of Miami, and I specialize in thoracic oncology and also head and neck [cancer]. I’m a medical oncologist.

Dr. Leal: Let’s start talking about the initial screening and diagnostic process for patients with lung cancer, focusing here on lung cancer screening—not only the considerations, but also the challenges. I’ll start by asking you your opinion on how lung cancer screening has helped in terms of stage shift and how you view the multidisciplinary team in the lung cancer screening process.

Dr. Merritt: Lung cancer screening is a very important part of early detection for lung cancer. Some of the current challenges are the lack of awareness of the eligibility criteria by primary care physicians, who primarily are the main referrers of patients who meet criteria for lung cancer screening. As a result, a very low percentage of eligible patients are actually getting screened. But the good news is that there are two randomized clinical trials, which demonstrate a decrease in lung cancer–related death in patients who were screened for lung cancer. With that in mind, I think it’s a very essential part of early detection.

One of the other challenges is, if you do pick up abnormal lung nodules, it requires multidisciplinary input from thoracic surgeons, pulmonologists, and also primary care physicians to decide which lesions require biopsy and which ones require additional scans. Those are some of the inherent challenges in lung cancer screening.

Dr. Antonoff: I’d echo what you said Robert, and I think there are some additional challenges beyond that. Certainly, NLST [National Lung Cancer Screening Trial] and NELSON both showed significant increases in early detection with low-dose [CT] screening and mortality reduction, but this is in patients who [were] already felt to be at higher risk. These are patients who are in at-risk populations who are being screened.

We have two separate challenges. Number one: uptake is still a barrier. In underserved populations, patients still might not be getting screened even if they should be. That’s a challenge that we deal with in patients who do meet those criteria—being at increased risk for lung cancer based on their age or their smoking history. The other issue we have is that we’re seeing more and more patients who don’t qualify for lung cancer screening because they’re nonsmokers or they’re particularly young. Those patients—they still continue to present with advanced-stage disease.

Clearly, while we know there’s an important role for lung cancer screening, and it’s allowing us to find more of the patients at an earlier stage, we recognize that there are substantial limitations to using this type of imaging study in patients who are just deemed to be at risk.

Certainly, there’s room as we develop more screening strategies to hopefully eventually develop blood-based biomarkers and other ways to incorporate algorithms that will help us identify patients at earlier stages in populations who may not be easy to get to a CT scanner or who may not even be considered for screening.

Dr. Leal: Good point. In terms of getting a positive screen—and I know that can mean different things—how do you coordinate that? And how do you deal with the pathways and process and, importantly, the patient communication in getting the results and the next steps for patients?

Dr. Merritt: That’s a great question. In my institution we use the Lung-RADS scoring scale. Patients with 4A or 4B lesions are deemed to be at high risk for lung cancer. We have a consultation discussing the options in terms of biopsy versus continued surveillance. For the 4B patients, which are the highest risk, we counsel patients that biopsy would probably be a better option.

Then, that discussion is the risk-benefit [balance] of the biopsies, of the different techniques for biopsy. If there is a lung cancer detected, then the discussion is: what are the best therapeutic options? It does require quite a bit of patient communication and sometimes some multidisciplinary input from our pulmonary colleagues who often perform a lot of the biopsy procedures to diagnose lung cancer.