What the study found
Researchers at Thomas Jefferson University in Philadelphia looked at a question the screening literature had mostly skipped: are the women already enrolled in a lung cancer screening program up to date on their breast exams? Their analysis, published July 3, 2026 in the Journal of the American College of Radiology, covered patients screened in the health system's centralized lung cancer screening (LCS) program between 2018 and 2025 — nearly 4,400 patients, of whom 2,100 were women also eligible for breast cancer screening.
The answer: not really. About 54% had completed screening mammography within one year of their low-dose CT, and 67% within two years. For comparison, the national estimate cited in the study approximates that almost 80% of women undergo screening mammography within two years — what the authors call a "meaningful gap in screening completion among LCS participants."
These are patients the health system already sees every year. They show up, they get scanned, they leave — and a substantial share of them leave without the other cancer screening they qualify for.
| Population | Mammography within 1 year of low-dose CT | Within 2 years |
|---|---|---|
| Dual-eligible women in the LCS cohort (n = 2,100) | ~54% | 67% |
| U.S. women overall (national estimate cited in study) | — | ~80% |
Figures rounded as reported by Radiology Business from the JACR analysis (Maceyko et al., 2026). The cohort was screened in a single academic medical center's centralized LCS program.
The highest-risk patients are the ones falling through
The pattern inside the gap is what makes it clinically uncomfortable. Greater pack-years of smoking and a personal history of cancer were both significantly associated with being overdue for breast screening. In the authors' words, patients at higher overall cancer risk "paradoxically" showed lower adherence — "underscoring a critical gap in preventive care delivery." Black women, by contrast, were significantly less likely to be overdue than white women in this cohort.
One subtler finding: women with COPD documented in the electronic health record were less often overdue for mammography, while those with only self-reported COPD were overdue more often. The authors read EHR-documented disease as a proxy for engagement with the health system — more contact, more chances to complete screening — while self-reported disease "may capture a more heterogenous population with lower health literacy or barriers to care." They caution the self-report finding rests on a modest absolute difference.
The takeaway for program design is direct: adherence problems concentrate in exactly the patients screening is supposed to protect, and system contact — not patient motivation alone — is what closes the gap.
Why experts want one-stop screening
Earlier studies had already shown the reverse flow works: breast screening programs can identify women eligible for lung cancer screening and improve low-dose CT uptake. The Jefferson team argues their data reveals "a reciprocal opportunity, potentially leading to an integrated screening framework in which participation in one cancer screening program facilitates engagement in others."
The LCS cohort is a particularly efficient place to start. As lead author Meghan Maceyko, MD, and colleagues put it, dual-eligible women "can be more efficiently identified from an [lung cancer screening] cohort than from a [breast cancer screening] cohort" — and LCS participants may already have access to structured navigation pathways that could carry a mammography order along with the annual CT. Their recommendation: "embedding navigation and coordinated scheduling in LCS workflows" as part of coordinated, multi-cancer screening strategies that "may amplify the impact of individual screening programs."
Note what this is not: it is not a change to who qualifies. Eligibility rules for low-dose CT are their own moving target — covered separately in the breakdown of the proposed simpler lung cancer screening criteria. This is about how programs run: turning two parallel screening pipelines into one coordinated visit.
The operational playbook for combined screening
For outpatient imaging centers and hospital screening programs, "integration" translates into four concrete workstreams:
1. Capture eligibility in both directions
Ask the mammography question at LCS intake and the smoking-history question at mammography intake. The study found dual-eligible women are easier to find inside an LCS cohort — the roster already exists. An EHR flag for "LCS participant, mammography overdue" costs little and produces a ready-made outreach list.
2. Coordinate scheduling toward one visit
The authors explicitly recommend embedding coordinated scheduling in LCS workflows. Practically, that means offering the screening mammogram on the same day as the annual low-dose CT, or booking both from a single navigation call. Every separate trip is another chance to drop out — and the data shows who drops out: the highest-risk patients.
3. Use the navigators you already have
Centralized LCS programs run structured navigation — eligibility verification, shared decision-making, follow-up tracking. Extending that pathway to carry breast screening completion is cheaper than building a second navigation program, and it targets the population where the adherence gap is documented.
4. Plan reporting capacity before the volume arrives
Combined screening deliberately increases imaging per visit. Closing even part of the gap between 67% and ~80% across a 2,100-woman cohort means finding capacity for a few hundred additional mammograms — and the reciprocal flow that prior studies demonstrated adds low-dose CTs, the heavier read. Scanner slots flex; reader hours are the scarce input.
The bottleneck moves from acquisition to reporting
A one-stop screening visit is an acquisition-side win with a reporting-side bill. A screening mammogram and a low-dose chest CT are both quick to acquire — but each low-dose CT demands a careful read: nodules found and measured, comparison against priors, Lung-RADS categorization, a documented follow-up recommendation. Multiply that by a program that is now actively recruiting from its sister screening pipeline, and the constraint is no longer the scanner schedule. It is the reading queue.
This is where AI CT reporting fits the integrated-screening picture. A foundation-model approach produces a comprehensive, structured draft for each chest CT — findings described and measured, formatted into a ready-to-sign report. xAID's in-house radiologist reviews every preliminary before delivery, and your radiologist signs the final. The screening program absorbs the added read volume without needing radiologist headcount to grow in step with it.
The study's closing argument is about equity as much as efficiency: optimizing breast screening within the LCS population "may have the potential to reduce screening disparities and increase early breast cancer detection through a tailored approach for high-risk women." Programs that want that outcome should assume the imaging volume that comes with it — and build the reporting capacity first.
Frequently asked questions
What did the JACR study on breast and lung cancer screening find?
Researchers at Thomas Jefferson University analyzed nearly 4,400 patients in a centralized lung cancer screening program between 2018 and 2025, of whom 2,100 were women also eligible for breast cancer screening. About 54% had completed screening mammography within one year of their low-dose CT, and 67% within two years — well below the national estimate that almost 80% of women complete screening mammography within two years. The analysis was published in the Journal of the American College of Radiology on July 3, 2026.
Why do experts want breast and lung cancer screening programs integrated?
Because each program is a captive audience for the other. Prior studies showed mammography visits can identify women eligible for lung cancer screening; the new JACR study shows the reciprocal gap — women already engaged in lung screening are falling behind on mammography. The authors call for an integrated framework in which participation in one cancer screening program facilitates engagement in others, using coordinated scheduling and navigation embedded in lung screening workflows.
What does combined breast and lung screening mean for an imaging center's operations?
Three things change: eligibility capture must run in both directions (smoking history at mammography intake, mammography status in lung screening navigation), scheduling must support same-visit or closely coordinated exams, and reporting volume rises faster than acquisition time. A combined visit adds a mammogram and, in the reciprocal flow, more low-dose CTs — each low-dose CT requiring nodule assessment, comparison against priors, and Lung-RADS categorization. The bottleneck moves from the scanner to the reading queue.
How can a lung cancer screening program absorb more CT reads without adding radiologists?
By raising throughput per radiologist rather than headcount. AI CT reporting generates a structured, ready-to-sign draft for each low-dose chest CT — xAID's in-house radiologist reviews every preliminary, and your radiologist signs the final. The radiologist stays accountable for every read, while the repetitive drafting and measurement work that scales with screening volume is absorbed by the AI-drafted report.
Source: Maceyko M, et al. "Screening Mammography Completion Among Women Enrolled in a Lung Cancer Screening Program," Journal of the American College of Radiology, published online July 3, 2026 (doi.org/10.1016/j.jacr.2026.06.017, open access), as reported by Radiology Business. Figures are rounded as reported.