Lung cancer Lung cancer continues to be the leading cause of cancer death in the U.S., yet screening rates remain low. One major reason is the stigma tied to smoking, which discourages many people from seeking care. To change this, education, training, and awareness about both lung cancer and tobacco-related health effects are essential. “Lung cancer is not as well-advertised as other cancers, like breast cancer, so many people do not think about lung cancer screening,” said Dr. Niharika Khanna, a medical professor at the University of Maryland, who also leads the Maryland Tobacco Control Resources Center. “We work closely with the state to provide education, training, increase awareness about tobacco and all the related health effects in the community.”
The Greenebaum Comprehensive Cancer Center at the University of Maryland is conducting a large project addressing lung cancer treatment barriers. This includes developing a lung cancer screening eligibility tool, better management of incidental nodules and even using a mobile van to go into the communities. Dr. Khanna is specifically focused on tobacco screening education. “Our goal is to go out to all of the practices that are a part of the University of Maryland six-cancer center network, which is about 141 practices,” Dr. Khanna explained.
Using EPIC Systems Corporation electronic health records, the practices involved will be able to easily refer individuals to lung cancer screening. “We will go to each practice and invite them to trainings that will give them a better understanding of screening and treatment for tobacco use, as well as when and how to refer for lung cancer screening.”
Personalized Treatment to End Smoking Dependence
The journey of quitting tobacco can seem overwhelming, which is not helped by the stigma that often accompanies tobacco use and lung cancer. Currently, screening is only available to adults 50 and older, so at this point many have had an almost lifelong dependence on nicotine. “Often the biggest fear the patient has is giving up that cigarette that’s been sort of a comfort their whole life. “Changing a lifestyle is what this is about, but that is not easy,” said Dr. Khanna.
“We want to help anyone who is considering some sort of tobacco treatment. That does not have to be immediate cessation. We do not want any patient to feel like they must quit today. It is going to be a slow journey, and we want to give them the tools to succeed long term,” she added.
Through the program, people who are interested in quitting smoking and are not sure how, can turn to a tobacco treatment specialist for resources and support. “We answer their questions about the medications, come up with a treatment strategy and then continuously follow up with them to see if they have any questions,” said Colleen Kernan, a tobacco treatment specialist and project coordinator with Dr. Khanna’s team. “We just want to really be there to support them through their cessation journey.”
The treatment specialists personalize each experience by delving into an individual’s smoking history and uncovering what has and hasn’t worked for them in the past. From there, education is key, specifically when it comes to nicotine replacement therapy (NRT). “We want them to go home and focus on taking the medication as prescribed and, in time, we hope that we are retraining the brain so that eventually cigarettes are no longer a point of interest,” explained Kernan. “We want them to concentrate on what they can control and let them know that it is ok to have setbacks. We are here for the long haul.”
The multiprong approach to nicotine replacement therapy the program is promoting includes giving the patient one long-acting daily medication, and one specifically for cravings.
Applying Shared Decision-Making
Currently, Dr. Khanna’s team hosts a lung cancer screening page on the Maryland Tobacco Control Resource Center pathway. The page includes a plethora of resources for individuals who feel stigmatized, which may make them less likely to get lung cancer screening. “They need to learn more about why they’re getting screened and what will happen if anything comes up on the screening,” Dr. Khanna explained.
First, providers need to start screening for smoking, which can only happen if patients share a good medical history. Under the current guidelines, this includes anyone 50-80 years of age with a 20 or higher pack-year history (people who smoked 1 pack/day for 20 years, 2 packs/day for 10 years etc.) who currently smoke or have quit within the last 15 years.
Next, they hope to link each patient to the quit line, a referral that can happen directly through EPIC. “We use tobacco as our fifth vital sign in EPIC. Then use shared-decision making to help the patients with any concerns they may have while also referring them to a low-dose CT scan,” Dr. Khanna explained. If there is a negative result, these patients will be encouraged to schedule a follow-up scan for the next year. If there's a positive result, the healthcare provider will facilitate the next steps.
I am confident that our pathway is going to work, but we will be measuring to see if our education and training is making an impact and make changes as needed,” she continued.
Dr. Khanna and her team hope that their program will make a difference in screening for both patients and practices. To learn more about lung cancer screening, visit SavedByTheScan.org.
Blog last updated: September 30, 2025
