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BTOG 2026 | How to communicate overdiagnosis risk in lung cancer screening programs
Anna Bibby, MBChB, PhD, North Bristol NHS Trust, Bristol, UK, comments on the challenges of quantifying and communicating the risk of overdiagnosis in lung cancer screening programs, highlighting the complexities of individual risk perception and the need for effective communication strategies to reduce anxiety-driven cascade investigations. Participants in screening programs often have different interpretations of risk, and there is often a disconnect between the clinical perspective on overdiagnosis and the patient’s perspective, where a benign result is often seen as a positive outcome. This interview took place at the 2026 British Thoracic Oncology Group (BTOG) congress in Edinburgh, UK.
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Transcript
Again, that’s a really important question. And like I mentioned before, communicating risk is very, very difficult. And we know from qualitative work with participants, not just around screening, but around trial participation, that actually people interpret risk very differently. And we all know people in our lives, right, who always assume the worst, so if you mention any possibility of risk, they’ll think it’s going to apply – it’s a definite – and then equally, there are other people who are sort of, you know, happy-go-lucky, “Oh, this doesn’t really apply, it’ll never happen to me...
Again, that’s a really important question. And like I mentioned before, communicating risk is very, very difficult. And we know from qualitative work with participants, not just around screening, but around trial participation, that actually people interpret risk very differently. And we all know people in our lives, right, who always assume the worst, so if you mention any possibility of risk, they’ll think it’s going to apply – it’s a definite – and then equally, there are other people who are sort of, you know, happy-go-lucky, “Oh, this doesn’t really apply, it’ll never happen to me.” Um, and particularly, actually, with healthy volunteers or healthy participants – so people that we’ve invited into screening who don’t have symptoms, feel fine. I suspect that the majority of them would hear about potential risks and brush them off and think, “Oh, not going to happen to me.” So there’s a big issue about communication in a way that allows participants to distill, accept, and believe. And that’s a world of work in terms of overdiagnosis in screening – again, that’s a very particular kind of element, because all of us who work in screening programs have had participants flagged through screening with a nodule, gone on for surgery, had the nodule resected, and it was benign, which for us as clinicians is bad – it’s a failure – we’ve put the person through an unnecessary operation for something that would never have harmed them. But inevitably, that person is always very grateful because they sort of say, “You found something, you treated it, and it turned out not to be cancer.” So it’s a win all round. And there’s a disconnect there, right? And that needs to be addressed, I think. I don’t know how you do that – um, I think there’s some complicated sort of mixed-methods qualitative work to be done with people around that, because I think yeah, the overriding message that comes back from participants is, “It’s always better to know – you know, at least it’s out now, and I know it wasn’t anything to worry about,” so yeah, we need to work on that – I don’t know how, but we do.
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