The 47,000 Deaths That Pope Leo Made Visible: Inside the Lung Cancer Screening Gap
A papal diagnosis brought lung cancer back into the headlines. The data behind the screening gap has been there all along.
On October 13, 2026, a team of surgeons at Rome's Gemelli Hospital removed the lower lobe of Pope Leo XIV's right lung. The Vatican confirmed what pre-operative tests had suggested: pulmonary adenocarcinoma. The procedure was described as successful. No complications. His post-operative course, the Vatican said, is normal.
Within hours, lung cancer was trending. Search volume spiked. Clinics reported phone calls from people asking about screening. Coverage ran in every major outlet. Then, within a few days, the story faded into the next news cycle.
That is the predictable arc of celebrity diagnosis coverage. A famous person gets sick. The public briefly notices. Nothing structural changes.
Here is what did not make the news cycle: the American Cancer Society had already published a rigorous model showing that full screening of all eligible Americans could prevent roughly 62,110 lung cancer deaths over five years. At current rates, we prevent about 14,970 of those. That leaves approximately 47,140 preventable deaths in the gap, every five years, not because the tool does not work, but because most people who should get it never do.
Pope Leo's diagnosis did not create that gap. It just made it visible, briefly, to people who do not spend their days reading radiology journals.
This piece is for the ones who do, and for the health system operators, FQHC leaders, radiology administrators, and benefits directors who can do something about it. We will walk through what the Vatican actually disclosed, why two credible surveys produce two different screening rates, what stage at diagnosis does to survival, who the system keeps missing, what a working pathway looks like in practice, and where technology fits honestly into that picture.
1. What the Vatican said, and what it did not
The facts released publicly are narrow, and they were released slowly.
The nodule was found during routine medical checks, according to the pope's own statement. Surgeons at Gemelli, led by thoracic surgeon Dr. Stefano Margaritora, performed a video-assisted resection targeting what they called a radical removal of the right lower lobe. Intraoperative examination confirmed adenocarcinoma. The surgery lasted roughly 90 minutes.
What has not been disclosed: the stage of the cancer, whether lymph nodes were involved, what imaging method first detected the nodule, and his smoking history. Some early reports speculated about the stage based on the resection approach. Those speculations remain unconfirmed by the Vatican.
That ambiguity matters for one reason: it is tempting to make Pope Leo's diagnosis into a clean narrative about the power of early detection. Maybe his cancer was found early because of a well-designed surveillance program. Maybe it was incidental. We do not know. And turning an unconfirmed story into a public health parable has a long history of backfiring when the facts come out differently.
What the case does do is create an opening. When a head of state announces a lung cancer diagnosis, the general public becomes briefly receptive to information about lung cancer. People who have never thought about screening eligibility ask their doctors. Clinics get calls. The question for health system operators is whether the pathway is ready to absorb that attention, or whether the interest evaporates because nothing actionable is easy to find.
Right now, for most health systems, the pathway is not ready.
2. Two surveys, two numbers, one persistent problem
Search for the national lung cancer screening rate and you will find 18.7%. You will also find 24.5%. Both numbers are real. They come from different surveys with different methodologies, and understanding the gap between them is more useful than picking one.
The 18.7% figure comes from an American Cancer Society analysis published as a research letter in JAMA in November 2025. The researchers used the 2024 National Health Interview Survey. Among adults ages 50 to 80 who had ever smoked, 2,124 respondents met 2021 USPSTF eligibility criteria. Weighted to the national population, that represents about 12.76 million Americans. Of those, 18.7% were up to date on lung cancer screening. Priti Bandi, Ph.D., a senior principal scientist at ACS, summarized the finding plainly: roughly three times more deaths could be prevented if everyone eligible were screened.
The 24.5% figure comes from a research letter published April 27, 2026, in JAMA Internal Medicine. Todd Burus, Ph.D., and colleagues at the University of Kentucky used the 2024 Behavioral Risk Factor Surveillance System, a larger state-based telephone survey. Among 26,104 eligible respondents, 24.5% had been screened within the past year, a gain of about six percentage points from 2022 BRFSS data.
Why the gap between the two numbers? Different survey architectures produce different response patterns. Different questions get different answers. The NHIS analysis had a 47.9% response rate, which itself introduces uncertainty. Neither survey is wrong. They bracket a range. Somewhere between roughly one in five and one in four eligible Americans is actually getting screened.
For a health system leader, the useful reading is not which number to cite. It is that even the better number means three out of four eligible patients in your catchment area are not getting a scan that is fully covered, without cost sharing, by Medicare and by most ACA-compliant private plans. The clinical tool is free to patients who qualify for it. Three in four still do not get it.
One comparison sharpens the picture: a separate JAMA study examined 11,147 adults who were eligible for both breast cancer screening and lung cancer screening. About 65% had a mammogram in the prior year. About 18% had low-dose CT for lung cancer. Same population. Two different tools. One has achieved broad uptake. The other has not.
3. The gap in lives: what the model says
The ACS analysis in JAMA went beyond measuring uptake. It modeled what lung cancer screening could do over five years if it actually reached eligible adults.
The model drew on the National Lung Screening Trial, which found that annual low-dose CT reduced lung cancer mortality by 20.4% compared with chest X-ray. That figure served as the effect estimate. Applied to the roughly 12.76 million eligible Americans, the analysis projected:
At 100% uptake: approximately 62,110 deaths prevented and 872,270 life-years gained over five years.
At current uptake (18.7%): approximately 14,970 deaths prevented and 190,030 life-years gained over five years.
The arithmetic is direct. Current screening is delivering roughly 24% of what full screening could deliver. Subtract 14,970 from 62,110 and you get 47,140 preventable deaths not being prevented. That is the number behind this article's headline.
To be precise about what this figure is and is not: it is a modeled estimate grounded in trial data, not a registry count. Effect sizes from clinical trials do not always translate to routine practice at the same magnitude. A VA Health System study published alongside the Kentucky letter found higher all-cause mortality among screened veterans compared with National Lung Screening Trial participants, suggesting that real-world benefit may be smaller than trial benefit. The authors of that study do not argue against screening. They argue for quality: standardized reporting, competent reading, and robust follow-up. The gap between trial efficacy and real-world effectiveness is a reason to invest in pathway quality, not a reason to screen less.
But even if the real-world effect is half what the trial showed, the preventable death toll from low uptake is still enormous. The math does not become comfortable at any plausible discount.
The ACS analysis also modeled screening among the 28.08 million adults ages 50 to 80 who have smoked but do not meet current USPSTF eligibility criteria. Including them could, in theory, prevent an additional 29,690 deaths and gain 482,410 life-years. This raises harder questions about harms, false positives, and cost-effectiveness at the margin. Multiple oncology organizations have urged caution before expanding criteria ahead of trial evidence. We address that debate in section 5.
For now, the near-term arithmetic is clear. The biggest available gain is among the people who already qualify and are not getting scanned.
4. Stage is the whole game
The reason screening matters comes down to one table in the SEER database.
Among lung cancers diagnosed between 2016 and 2022, about 24% were found at a localized stage. Five-year relative survival for localized lung cancer is 65.5%. About 21% were diagnosed at the regional stage, with 38.2% survival. About 51%, half of all diagnosed cases, were found at the distant stage, meaning the cancer had spread to other organs or distant lymph nodes. Five-year relative survival for distant-stage lung cancer is 10.5%.
Read those numbers one more time. Half of all lung cancers are found after they have spread to distant sites. For those patients, roughly nine in ten will not be alive in five years. For the quarter caught while localized, about two in three will be.
The argument for early detection is not theoretical. The survival differential between stage I and stage IV lung cancer is one of the largest in oncology. Treatment has improved substantially. The American Cancer Society's 2026 statistics report shows overall five-year lung cancer survival rising from 15% in the mid-1990s to 28% now. Distant-stage survival rose from 2% to 10%. Regional-stage survival rose from 20% to 37%. These are meaningful gains from better therapeutics, including targeted agents and immunotherapy.
But the single largest lever, shifting diagnosis from distant to localized stages, remains mostly unpulled. Screening is the primary mechanism for that shift. No drug changes where a cancer is found. Screening does.
Adenocarcinoma, the subtype in Pope Leo's diagnosis, is notable in this context. It is now the most common form of non-small cell lung cancer, has a higher representation among never-smokers than other subtypes, and tends to present peripherally, where low-dose CT is effective. Stage at diagnosis still determines outcomes for adenocarcinoma as much as for any other subtype. Early-stage adenocarcinoma is among the most treatable cancers in the SEER database. Late-stage adenocarcinoma is not.
5. Who the system keeps missing
The Kentucky BRFSS analysis is valuable because it disaggregates the national average into its components, and the components tell a very different story by insurance status, geography, and race.
Screening uptake by insurance type in 2024: adults with military-related coverage screened at 39.05%, the highest of any group. Adults with employer-sponsored insurance screened at roughly 27%. Adults on Medicaid or Medicare screened at roughly 22 to 26%. Uninsured adults screened at 6.07%, and showed essentially no improvement between 2022 and 2024.
Screening by state ranged from 13.4% in South Dakota to 38.4% in Massachusetts. The highest-rate states clustered in the Northeast. Southern states, where lung cancer burden is high, consistently screened lower. A prior analysis of 2022 BRFSS data linked higher state screening rates to Medicaid expansion and greater radiology capacity. States that expanded Medicaid early showed systematically better screening penetration.
Screening by race: Hispanic, Asian, and Black adults all screened at lower rates than white adults and showed no statistically significant gains between 2022 and 2024.
Screening by age: uptake was 11.3% among adults ages 50 to 54, rising to just over 31% among those ages 75 to 79. The youngest eligible patients, who have the most life-years to gain from early diagnosis, are the least likely to be screened. The reasons are structural: primary care visits are less frequent among younger working-age adults, smoking history documentation is less complete, and awareness of eligibility is lower.
Insurance coverage design adds another layer. Medicare covers annual low-dose CT for beneficiaries ages 50 to 77 with at least a 20 pack-year history who currently smoke or quit within the past 15 years. The ACA requires most private plans to cover the initial scan without cost sharing. The problem is that the pathway does not end at the scan. Follow-up imaging, diagnostic bronchoscopy, tissue biopsy, and specialist consultations can carry copays, coinsurance, and deductibles under plans that cover only the initial screen. A patient who gets the scan and then receives a Lung-RADS 3 or 4 result may face out-of-pocket costs they cannot manage at exactly the moment they most need to engage.
New York addressed this directly. On December 4, 2025, Governor Hochul signed legislation requiring state-regulated insurers, including Medicaid, to cover follow-up screening and diagnostic services for lung cancer without cost sharing. The law takes effect January 1, 2027. It is one of the most specific policy interventions targeting the follow-up dropout point. Whether other states follow will depend on whether advocates can make the dropout data visible to legislators the way the ACS model made the death gap visible to researchers.
The never-smoker question is also real and growing. A 2026 review in the ASCO Educational Book estimated that 15% to 25% of lung cancers worldwide occur in people who never smoked. In the TALENT study, a prospective trial of never-smokers, the cancer detection rate was 2.6%, compared with 1.1% in the National Lung Screening Trial, and 96.5% of detected cancers were stage 0 or I. Several researchers have argued that excluding never-smokers cannot be justified given these detection rates. Others, including cancer center leadership at the University of Kentucky, have urged caution before widening criteria ahead of randomized mortality data. Both positions are defensible. Neither changes the near-term math: the largest available gain is among people who currently qualify and are not being reached.
6. What a working pathway looks like: the CommUnityCare model
The CommUnityCare Health Centers study is the most useful published evidence for safety-net operators trying to build a lung screening program.
CommUnityCare is a large FQHC system serving Central Texas. Between 2020 and 2023, its team built and ran a structured lung cancer screening implementation. Researchers published the results in the American Journal of Preventive Medicine in September 2024. The patient population was about 36% Latino and 18% African American. About 14% were uninsured, 48% were in a county medical assistance program, 27% were on Medicare or Medicaid, and 77% currently smoked.
The implementation used a multi-layer identification approach: EHR queries to surface likely eligible patients, direct provider referrals at the point of care, and outreach mailings to patients not recently seen. Identified patients were routed to a bilingual social worker who confirmed eligibility, conducted telehealth shared decision-making visits, coordinated CT scan scheduling, and offered smoking cessation support. For uninsured patients, financial assistance covered the cost of the scan. A board-certified chest radiologist reviewed all images for quality and refined initial reads, reducing false-positive rates. Patient navigators tracked Lung-RADS 3 and 4 findings through to follow-up workup.
The results:
Of 650 patients who completed shared decision-making, 636, or 98%, agreed to screening. Of those, 528 completed the CT, about 83%. Median time from referral to CT completion was 27 days. Completion exceeded 80% across subgroups, and differences by race, insurance status, and smoking status were not statistically significant.
Among screened patients, 88% had Lung-RADS 1 or 2 results (no significant finding). About 9% had Lung-RADS 3 (probably benign, short-term follow-up imaging recommended). About 3% had Lung-RADS 4 (suspicious, further diagnostic evaluation warranted). Seven patients, 1.3%, were diagnosed with cancer.
The referral pathway made a substantial difference in completion. Of 629 patients referred directly by providers, 579, or 92%, completed shared decision-making. Of 479 patients reached by mailed outreach, 108 were eligible and 71 completed shared decision-making, about 66%.
What CommUnityCare demonstrates is not that FQHCs have magical access to hard-to-reach populations. It is that when the pathway is engineered end to end, when eligibility is confirmed systematically, when the decision-making visit happens proactively, when the scan is financially covered, and when follow-up is tracked by a named person, a population that is mostly Latino, often uninsured, and predominantly current smokers will complete screening at rates the national surveys have not come close to approaching.
The lesson for health system operators is operational, not clinical. The clinical case for screening is settled. What is not settled, at most institutions, is who owns each step of the pathway.
What this means for health systems, FQHCs, and radiology teams
Pope Leo's diagnosis gave health systems a brief window of public attention. Here is what to do with it, in order of immediate impact.
**Measure what you have.** Ask your analytics team how many patients in your panel meet USPSTF criteria and how many had a documented shared decision-making visit and a low-dose CT in the last 12 months. If the answer is "we do not track this," that is your first finding. You cannot improve a number you cannot see.
**Build the referral pathway before the awareness campaign.** Awareness without capacity is waste. If a patient who calls after reading about Pope Leo's diagnosis cannot get an eligibility check, a shared decision-making visit, and a scheduled scan within 30 days, the attention converts to nothing. CommUnityCare achieved a 27-day median. That is a reasonable target.
**Assign a named person to Lung-RADS 3 and 4 follow-up.** This is where most programs fail. An abnormal scan with no follow-up owner does not save anyone. The navigator function does not need to be a high-cost clinician. It needs to be a person with a list who makes calls.
**Close the follow-up cost gap.** If your state has not moved on follow-up cost sharing, look at what New York did and make the financial case to your payer partners. The uninsured screened at 6.07% nationally. If your FQHC serves uninsured adults, the scan itself needs to be covered and the follow-up needs to be affordable, or the program is a funnel with a hole in it.
**Use the 47,000 as a planning figure.** It is a model, not a registry count. But it tells you the order of magnitude of what is not being done, and it gives benefits directors and payers a frame for the cost of late diagnosis versus the cost of an annual low-dose CT. The math is not close.
For radiology groups: the question is whether you have the capacity to absorb increased referrals, standardized Lung-RADS reporting, and a chest-trained reader on every low-dose CT. Volume will eventually arrive. The practices with a structured screening program in place will capture it.
For FQHCs: the CommUnityCare model is a proof of concept, not a template that transfers wholesale to every system. But its core elements, systematic EHR-based eligibility identification, telehealth decision-making, financial coverage for the scan, and navigator-managed follow-up, are replicable. The question is whether lung screening is a program with a budget and a workflow, or an aspiration waiting for someone to own it.
About
Jonathan Govette is Co-Founder and CEO of Oatmeal Health, which builds AI lung cancer diagnostics to catch cancers earlier in underserved communities. Oatmeal Health's LungAI is investigational and not FDA cleared. Jonathan writes The Oatmeal Bite for health system leaders, FQHCs, and radiology teams navigating the intersection of technology, policy, and population health.
Key References
Vatican announcements of surgery and diagnosis, October 13 to 14, 2026. Surgery performed at Gemelli Hospital, Rome, by Dr. Stefano Margaritora. Adenocarcinoma confirmed on intraoperative examination. Stage not publicly disclosed. Reported by CBS News, NPR, and MedHeadlines.
Bandi P, et al. Lung cancer deaths prevented and life-years gained from lung cancer screening. JAMA research letter, November 19, 2025, DOI 10.1001/jama.2025.19798. Used 2024 NHIS; estimated 12.76 million eligible adults; 18.7% up to date; modeled 62,110 deaths preventable at full uptake vs 14,970 at current uptake. Via The ASCO Post and AuntMinnie. Managed Healthcare Executive October 15, 2026, for mammography comparison (65% vs 18%).
Burus T, et al. Lung cancer screening uptake using 2024 BRFSS. JAMA Internal Medicine research letter, April 27, 2026. 24.5% uptake nationally; state range 13.4% (South Dakota) to 38.4% (Massachusetts); uninsured 6.07%; military-related coverage 39.05%. Via AuntMinnie (April 30, 2026) and Managed Healthcare Executive (May 21, 2026).
Rustagi A, et al. All-cause mortality in Veterans Health Administration lung cancer screening participants vs NLST participants. JAMA Network Open research letter, April 27, 2026. Via AuntMinnie.
National Cancer Institute SEER Cancer Stat Facts: Lung and Bronchus Cancer, 2026 estimates using 2016 to 2022 data. Five-year relative survival: localized 65.5%, regional 38.2%, distant 10.5%. Stage distribution: localized 24%, regional 21%, distant 51%.
American Cancer Society. Cancer Statistics 2026 press release. Estimated 229,410 new U.S. lung cancer cases and 124,990 deaths in 2026; approximately 20% of all cancer deaths. Overall five-year survival 28%, up from 15% in mid-1990s.
CMS National Coverage Determination 210.14. Lung Cancer Screening with Low Dose Computed Tomography, effective February 10, 2022. Age 50 to 77, 20 pack-years, currently smoking or quit within 15 years, shared decision-making visit required before first scan.
New York Governor's Office. December 4, 2025, signing of S2000A/A1195A. Requires state-regulated insurers including Medicaid to cover lung cancer follow-up screening and diagnostic services without cost sharing. Effective January 1, 2027.
CommUnityCare Health Centers implementation study. Villalobos-Gonzalez C, et al. American Journal of Preventive Medicine, September 2024. 650 shared decision-making completers; 636 (98%) agreed to screen; 528 (83%) completed CT; median 27 days; 7 cancers detected (1.3%). Via Radiology Business (October 8, 2024) and ASCO Post (October 2024).
Gorria T, et al. Never-smoker lung cancer screening review. ASCO Educational Book, 2026. TALENT study: 2.6% cancer detection rate; 96.5% stage 0 or I. Via AJMC.
Jiang B, et al. AI-first reader workflow for lung cancer screening. European Radiology, March 2026. 1,252 UKLS scans; 1.9% of cases were isolated typical perifissural nodules requiring radiologist review; 0 of 57 typical perifissural nodules malignant. One author employed by Coreline Soft.