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Hidden in plain sight: psychological barriers to participation in lung cancer screening

Lung cancer screening with low-dose computed tomography (LDCT) became an official recommendation in the US in 2013 in response to the scientific evidence supported by the US-based National Lung Screening Trial.1 In the years following the US implementation of lung cancer screening with LDCT, scientific evidence from subsequent international trials has supported the mortality reduction benefit of LDCT screening2 3 and is now recommended in Croatia, some regions of China and Korea, and is currently under review by the UK’s National Screening Committee. Despite the implementation of lung cancer screening, uptake remains low among screening-eligible individuals.4 Low uptake has conventionally been linked to, and supported by, evidence regarding lack of awareness, low knowledge levels and misinformation.5 6 However, as we consider the aetiology of suboptimal levels of lung cancer screening uptake and potential solutions, there are psychological consequences of lung cancer screening that are an important consideration as a potential barrier for patients who are weighing the option to screen, or not, for lung cancer.7–9 

Multiple studies have supported an increase in anxiety, depression and cancer worry among individuals who undergo lung cancer screening.7–9 Cancer …