Pope Leo XIV's lung cancer diagnosis puts a spotlight on low U.S. screening rates

Pope Leo XIV has lung adenocarcinoma, a common form of lung cancer, the Vatican said after surgeons removed the lower lobe of his right lung this week at Rome's Gemelli Hospital. The Vatican said the surgery was successful and there were no complications. The 71-year-old pope had announced days earlier that "doctors found a small, localized nodule in my lung" during routine medical checks and that it had been caught at a very early stage.

The Vatican has not said what kind of exam found the nodule, but the news is a reminder of how rarely lung cancer is caught early in the United States, where most people at high risk never get the scan designed to find it.

How many eligible adults get lung cancer screening?

Lung cancer is the leading cause of cancer death in the U.S. The American Cancer Society (ACS) estimated about 225,000 new cases and 125,000 deaths from the disease in 2025.

Annual low-dose CT (LDCT) screening lowers the risk of dying from lung cancer, but few eligible adults get it. An ACS study published in JAMA used 2024 National Health Interview Survey data and found that 12.76 million U.S. adults met federal screening criteria. Of those, 18.7% reported being up to date.

The researchers of the ACS study also estimated what that gap costs. If every eligible adult were screened, about 62,110 lung cancer deaths could be prevented over five years and 872,270 years of life gained. At current screening rates, the projected benefit is about 14,970 deaths prevented and 190,030 years of life gained.

“It's disappointing that lung cancer screening uptake remains this low,” lead author Priti Bandi, Ph.D., scientific director of cancer risk factors and screening surveillance research at ACS, said in a news release. “This low uptake is translating into a real missed opportunity, as three times more lung cancer deaths could be prevented (or lives saved) if everyone eligible were screened.”

Low uptake stands out next to other cancer screenings. A separate JAMA study using 2022 federal survey data looked at 11,147 adults eligible for both breast and lung cancer screening. About 65% had a mammogram, compared with about 18% who had lung cancer screening.

Who qualifies for lung cancer screening and who gets left out

Part of the challenge is that eligibility is harder to determine than for breast or colorectal cancer screening, which are based mainly on age. The U.S. Preventive Services Task Force (USPSTF) recommends annual LDCT for adults ages 50 to 80 who have at least a 20 pack-year smoking history and who still smoke or quit within the past 15 years. A pack-year equals smoking one pack a day for one year.

Medicare's coverage rules are narrower. For instance, CMS covers screening for beneficiaries ages 50 to 77 who meet the same smoking criteria, and it requires a counseling and shared decision-making visit before the first scan.

Professional groups have started to move past the USPSTF criteria as ACS dropped the years-since-quitting requirement from its guideline in 2023, and the National Comprehensive Cancer Network followed in 2025, according to the ACS. In the ACS study, researchers estimated that screening the 28.08 million adults ages 50 to 80 who have ever smoked but don't meet USPSTF criteria could prevent another 29,690 deaths over five years.

Access is also uneven. A research letter in JAMA Oncology that analyzed 2019 to 2023 federal survey data found that people without health insurance, people living in rural areas and people without a regular clinician were less likely to be screened.

How cost-sharing for follow-up tests affects lung cancer screening

Under the Affordable Care Act, most private health plans must cover the initial screening scan for eligible patients without cost-sharing. But that protection doesn't always extend to what comes next. When a scan shows a suspicious nodule, follow-up imaging, biopsies and specialist visits can come with copays, coinsurance and deductibles. The ACS Cancer Action Network has pointed to research showing these costs keep patients from completing the screening process.

States are starting to respond. New York Gov. Kathy Hochul signed a law late last year requiring state-regulated health plans, including Medicaid, to cover follow-up screening and diagnostic services for lung cancer without patient cost-sharing. The law takes effect Jan. 1, 2027.

When she signed the bill, Hochul said in a statement that “the last thing a patient should have to worry about is out-of-pocket costs” for follow-up screenings.