Good News, Bad News: 12 Years of Lung Cancer Screening Coverage in U.S. Newspapers

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Brent P. Little

Mayo Clinic, Jacksonville

What does the general public hear about lung cancer screening (LCS) from newspapers here in the United States of America? And why does what the public hears about LCS in the papers matter? Mass media is an important source of medical information for the public at large. Print sources, radio, television, online, and social media platforms all influence public knowledge of medical topics, but especially so for older adult populations, print media remains a truly trusted resource [1].

Public perception of LCS is particularly critical, since eligible individuals may not be aware of LCS opportunities, as well as the benefits and risks of screening with low-dose CT (LDCT). In-office discussion is often limited by time constraints; in a JAMA study from 2018, practitioners spent, on average, less than 1 minute discussing LCS [2]. According to findings from the U.S. National Lung Screening Trial, LCS with LDCT was associated with a 20% reduction in lung cancer-specific mortality [3], yet despite so many additional trials providing further support, LCS uptake continues to represent too small a fraction of the eligible population. Could the composition of coverage concerning LCS help to shape public understanding and influence the opinions of those eligible for LDCT screening? 

For AJR, my colleagues and I analyzed 12 years’ worth of LCS coverage in U.S. newspapers to assess the volume, tenor, and scope of that coverage [4]. The good news? Most of the coverage, itself, was good. And in could-be-better news, although many articles mentioned at least one benefit of LDCT LCS, additional important benefits were uncommonly included. The worst news, though? Critical logistics were seldom mentioned, and radiologists were infrequently interviewed.

From 2010 to 2022, a total of 859 articles mentioning LCS were included across a range of local, regional, and national newspaper sources. Weekly circulation sizes ranged from a low of 713 readers for one local paper to 1.2 million for the New York Times and 1.5 million for the Wall Street Journal. Annual article volume ranged from a high of 130 in 2014 (15% of the total) to a low of 33 (4% of the total) in 2020. Unfortunately for data, 2022 proved to be an incomplete year (Fig. 1).

Fig. 1—Line graph depicting number of U.S. newspaper articles covering LCS by year of publication, 2010–2022. Key developments in lung cancer screening are annotated by year. Study period included only first 3 months of 2022, resulting in lower number of articles for that year. LCS = lung cancer screening. NLST = National Lung Screening Trial, USPSTF = U.S. Preventive Services Task Force, LDCT = low-dose CT, AAFP = American Academy of Family Physicians.

The nadir of LCS coverage in 2020 coincided with the onset of the novel coronavirus disease (COVID-19) pandemic. Understandably, COVID-19 dominated the news that year, comprising about 25% of frontpage news articles for 2020 [5].

Of all articles, 25% were published during the month of November, Lung Cancer Awareness Month. It is gratifying to see LCS information so well disseminated during this month of greater public awareness, but such clustering reminds us: more sustained coverage throughout the year might be beneficial.

For a majority of articles, 76%, sentiment towards LCS was positive; moreover, negative sentiment comprised just 3% of the total. However, a higher proportion of negative sentiment (8%) came from articles on the highest quartile of weekly circulation (i.e., the most widely read newspapers).

Full articles appeared most commonly (65%), but short news briefs—often a small paragraph within a collection of multiple news items—accounted for a large proportion of the total article number (31%). Typically, these news briefs were limited in scope (e.g., an announcement for a screening program). 

Most articles (64%) mentioned at least one benefit of LCS: early detection and mortality reduction (49%). (Meanwhile, other benefits, such as the ease of LDCT or low radiation dosage, were rarely stated.) And we found it was a minority of articles (23%) that mentioned at least one potential risk.

Logistical aspects of LCS were infrequently stated, including updated recommendations for an annual CT examination until eligibility criteria are no longer satisfied (27%) and participation in a smoking cessation program (28%).  

Although many eligible individuals had questions regarding the potential cost or insurance coverage of LDCT LCS, we found it was a minority of articles (33%) that broached these subjects.

Importantly, despite playing a leading role in LCS programs, radiologists were mentioned or interviewed in a minority of articles (9%). Low media representation may be a missed opportunity to illustrate the importance of radiologists—and the field of imaging—to early cancer detection and management.

References

  1. Forman-Katz N, Matsa KE. News Platform Fact Sheet. Pew Research Center website. www.pewresearch.org/journalism/fact-sheet/news-platform-fact-sheet. Published September 20, 2022. Accessed October 19, 2023
  2. Brenner AT, Malo TL, Margolis M et al. Evaluating shared decision making for lung cancer screening. JAMA Intern Med 2018; 178:1311–1316
  3. National Lung Screening Trial. U.S. Department of Health and Human Services’ National Institute of Health, National Cancer Institute website. www.cancer.gov/types/lung/research/nlst. Accessed October 19, 2023
  4. Zippi ZD, Cortopassi IO, Johnson EM et al. U.S. newspaper coverage of lung cancer screening from 2010 to 2022. AJR 2023; 221
  5. Krawczyk K, Chelkowski T, Laydon DJ. Quantifying online news media coverage of the COVID-19 pandemic: text mining study and resource. J Med Internet Res 2021; 23:e28253
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