Lung cancer screening (LCS) programs have demonstrated the ability to detect malignancies earlier, allowing for potentially curative treatment.
At the VA Northern California Health Care System (VANCHCS), an expanded LCS program supported by the Lung Precision Oncology Program has yielded valuable insights into the management of high-risk nodules identified through the Lung Imaging Reporting and Data System (Lung-RADS), according to data presented at the 2025 World Conference on Lung Cancer.1 Specifically, the program’s evaluation of Lung-RADS 4 (LR4) nodules—indicating high malignancy risk—highlights both the successes of the screening initiative and opportunities for improvement.
Since its expansion in 2021, the hybrid LCS program at VANCHCS has achieved significant reach among eligible veterans. Of the 6509 veterans identified as eligible for screening, 81.2% were assessed, and 89% of those assessed were enrolled as of March 2025. The program utilizes low-dose computed tomography (LDCT) scans, guided by Lung-RADS, to assess risk and inform clinical decision-making. With 94.1% adherence to screening guidelines, the program reflects a high level of patient engagement and compliance.
LR4 nodules, which require prompt follow-up due to their elevated malignancy risk, offer a particularly valuable lens for evaluating the program’s diagnostic yield, staging outcomes, and timeliness of care.
The study aimed to assess diagnostic outcomes, pathology-confirmed malignancies, and cancer staging in patients with LR4 nodules. Researchers analyzed data from the VA’s LCS national dashboard, focusing on veterans with LR4 nodules detected on LDCT between 2021 and 2024. Key data points included demographics, biopsy timelines, pathology results, staging (using the AJCC 8th edition), and first specialty consultations.
Since the program’s inception, 10,155 LDCT scans have been performed, with 3946 veterans actively tracked. The program’s diagnostic yield for lung cancer was 3.3%, consistent with expectations for high-risk populations. Out of 122 cancer diagnoses in the LCS program, 82 veterans with LR4 findings were included in the final analysis (40 were excluded due to receiving subsequent care outside the VA system). The median time from LR4 detection to biopsy was 50.5 days, although significant variability was noted (range, 6-342 days).
Malignancies were confirmed in most biopsied nodules, with adenocarcinoma (n=32) and squamous cell carcinoma (SCC; n=21) being the most common diagnoses. Other non–small cell lung cancer (n=14) and small cell lung cancer (n=6) were also identified.
Almost 70% of cases diagnosed were at stage I, II, or IIIA/IIIB, the researchers noted, and all patients received timely referrals to specialty care, including radiation oncology, thoracic surgery, or medical oncology, based on the stage of disease and operability.
The expanded LCS program at VANCHCS demonstrates the effectiveness of Lung-RADS 4 as a tool for identifying high-risk nodules with a high malignancy yield. The predominance of adenocarcinoma and SCC diagnoses aligns with national trends, and the fact that 67% of cancers were detected at stages I-IIIA underscores the program’s success in enabling early intervention. However, the findings also highlight the importance of addressing delays in biopsy and improving documentation to further enhance outcomes.
By standardizing workflows, strengthening multidisciplinary coordination, and refining patient navigation, the program can build on its successes and maximize the impact of early lung cancer detection. As real-time data monitoring continues, the VANCHCS LCS program stands as a model for delivering high-quality, equitable care to at-risk veteran populations.
Reference
- Ochoa CD, Guru A, Zanfardino S, et al. Real-world outcomes of lung cancer screening and high-risk Lung-RADS 4 nodules at VA Northern California Health Care System. P1.04.16. Presented at: 2025 World Conference on Lung Cancer. September 6-9, 2025; Barcelona, Spain.