How a Billboard Saved One Woman from Lung Cancer
A Message Denise Lee Could Not Ignore
Denise Lee drove the same Northern California commute many times. During those trips, she repeatedly passed a billboard promoting lung cancer screening.
The message stood out. Denise had smoked for about 40 years, beginning at age 14. She had tried to quit several times before stopping in April 2017 with help from a prescription medication.
She did not have obvious lung cancer symptoms. She was not coughing up blood, struggling to breathe, or losing weight without an explanation.
Still, the billboard made her wonder whether she should be screened.
After seeing it several more times, Denise visited the campaign website, completed an eligibility quiz, and spoke with her doctor. She eventually received a low-dose CT scan.
Less than a day later, a pulmonologist called. The scan had found a mass in the upper lobe of her left lung. A biopsy later confirmed that it was cancer.
A billboard did not diagnose or treat Denise. It prompted her to ask for the screening test that found her lung cancer before symptoms appeared. Her experience shows why awareness and screening conversations can matter for people at increased risk.
What Happened After the Scan
The screening scan was only the first step.
After the abnormal result, Denise received diagnostic testing, including a biopsy. Her cancer was later described as stage IIB.
On March 7, 2018, surgeons removed the upper lobe of her left lung and 18 lymph nodes. The lymph-node evaluation did not show that the cancer had spread to those nodes.
Denise then received four rounds of chemotherapy. She also joined a clinical trial and received an immunotherapy drug once a month for one year.
In a February 2025 interview, Denise reported that she had not experienced a recurrence.
Her experience should not be reduced to one test or treatment. The billboard led to a screening conversation. The scan led to diagnostic testing, and her oncology team then developed a treatment plan that included surgery, chemotherapy, and clinical-trial participation.
Why Lung Cancer Can Be Found Before Symptoms
Lung cancer may not cause clear symptoms in its early stages. A tumor can sometimes grow for a period of time before it causes a noticeable cough, breathing problem, pain, or other warning sign.
That is why lung cancer screening is designed for certain people at high risk who feel well.
Screening is not intended for everyone. It is also not a replacement for paying attention to symptoms. A person who has possible lung cancer symptoms needs medical evaluation even if they do not qualify for routine screening.
What Is Lung Cancer Screening?
Lung cancer screening is testing performed in a person who has an increased risk of lung cancer but does not currently have symptoms.
The recommended screening test is a low-dose computed tomography scan, usually called a low-dose CT or LDCT.
An LDCT scan:
Uses X-rays and a computer to create detailed images of the lungs
Uses less radiation than a standard diagnostic chest CT
Is intended for certain people at high risk who do not have symptoms
Is generally repeated every year while a person remains eligible
Can detect small lung nodules that may not appear on a chest X-ray
LDCT does use radiation, although the dose is lower than that used for many diagnostic CT scans.
A chest X-ray is not considered an effective substitute for LDCT lung cancer screening.
Who May Qualify for Lung Cancer Screening?
Several organizations publish lung cancer screening guidelines. Their recommendations are similar, but they are not identical.
The American Cancer Society recommends annual LDCT screening for people who:
Are ages 50 through 80
Currently smoke or previously smoked
Have at least a 20 pack-year smoking history
Are healthy enough and willing to receive diagnostic testing and treatment if cancer is found
Unlike some other guidelines, the current American Cancer Society recommendation does not exclude a person simply because more than 15 years have passed since they quit smoking.
The U.S. Preventive Services Task Force, or USPSTF, recommends annual screening for adults who:
Are ages 50 through 80
Have at least a 20 pack-year smoking history
Currently smoke or quit within the past 15 years
The USPSTF recommends stopping screening after a person has not smoked for 15 years or develops a health condition that substantially limits life expectancy or the ability or willingness to have treatment intended to cure lung cancer.
These criteria are starting points, not a personal medical recommendation. Overall health, past imaging, treatment preferences, and other risk factors should be discussed with a healthcare professional.
What Is a Pack-Year?
A pack-year is an estimate of lifetime cigarette exposure.
One pack-year equals smoking one pack of cigarettes per day for one year.
The basic calculation is:
Packs smoked per day × years smoked = pack-years
Someone who smoked different amounts at different times may need to calculate each period separately and add the results.
See the pack-year examples in Table 1 below.
Screening Guidelines and Insurance Rules May Differ
Medical guidelines explain who may benefit from screening. Insurance policies determine whether a particular plan will pay for it.
Those are not always the same thing.
For example, the American Cancer Society does not currently use a 15-year limit for former smokers. The USPSTF and Medicare still do.
Medicare currently covers annual LDCT screening for eligible beneficiaries who:
Are ages 50 through 77
Have no signs or symptoms of lung cancer
Have at least a 20 pack-year smoking history
Currently smoke or quit within the past 15 years
Receive an order for the screening
Before the first Medicare-covered scan, the patient must also receive a counseling and shared decision-making visit. The visit includes discussing eligibility, benefits, risks, annual screening, smoking cessation, and the person’s ability and willingness to receive further testing or treatment.
Medicare requires the scan to be performed at a facility that uses a standardized system for identifying, classifying, and reporting lung nodules.
Most private health plans cover recommended preventive services, but network requirements, eligibility rules, prior authorization, and costs for follow-up testing can vary. A screening scan may be covered without cost-sharing while a later diagnostic scan or biopsy is handled differently.
Medical recommendations and insurance-coverage rules are not always the same, so patients should check with both their healthcare provider and insurer.
Screening Is Not the Same as Diagnostic Testing
Screening
Screening means testing a person who has an increased risk but does not have symptoms.
An annual LDCT performed under a lung cancer screening program is an example.
Diagnostic testing
Diagnostic testing is used to investigate symptoms, an abnormal screening result, or another suspicious medical finding.
It may involve a diagnostic CT scan, PET scan, bronchoscopy, biopsy, blood tests, or other procedures selected by the healthcare team.
People with possible lung cancer symptoms should not wait to see whether they qualify for screening. They should contact a healthcare provider for a diagnostic evaluation.
Possible Lung Cancer Symptoms
Possible symptoms include:
A cough that does not go away
A cough that becomes worse
Coughing up blood or blood-streaked mucus
Chest pain or discomfort
Shortness of breath
Hoarseness
Unexplained weight loss
Loss of appetite
Repeated pneumonia or bronchitis
New or worsening fatigue
These symptoms can be caused by many conditions other than cancer. Having one does not automatically mean a person has lung cancer. However, new, persistent, or worsening symptoms should be discussed with a healthcare provider.
Benefits of Lung Cancer Screening
For people who are eligible, annual LDCT screening may:
Find some lung cancers before symptoms appear
Find some cancers at an earlier stage
Increase the number of treatment options available
Reduce the risk of dying from lung cancer in high-risk populations
In the National Lung Screening Trial, LDCT screening reduced lung cancer deaths by about 15% to 20% compared with screening by chest X-ray among the high-risk population studied. That result does not mean every cancer will be detected or that every screened person will benefit.
Screening does not prevent lung cancer, and it cannot guarantee early detection or a cure.
Possible Risks and Limitations
Lung cancer screening can also cause harm.
A false-positive result is a test result that looks suspicious even though cancer is not present. It can lead to repeat scans, specialist visits, biopsies, anxiety, and, in rare cases, more invasive procedures.
Overdiagnosis means finding a cancer that may never have caused symptoms or shortened the person’s life.
Other limitations include:
Radiation exposure from repeated scans
Incidental findings in the lungs or other organs
Anxiety while waiting for follow-up results
Financial costs from diagnostic follow-up
A screening scan that misses a cancer
Complications from an unnecessary biopsy or procedure
Shared decision-making helps patients understand these tradeoffs before beginning annual screening.
What Happens if a Scan Finds a Lung Nodule?
A lung nodule is a small area that appears different from the surrounding lung tissue.
Lung nodules are common, and most are not cancer.
The next step depends on the nodule’s size, appearance, location, growth, and the patient’s risk factors. The care team may recommend:
Comparing the result with older scans
Repeating an LDCT after several months
Ordering more detailed imaging
Referring the patient to a lung specialist
Performing a biopsy when the risk is high enough
A small nodule does not automatically require surgery. Many nodules can be watched safely with follow-up imaging.
Why Many Eligible Adults Are Still Not Screened
Despite the potential benefit, screening remains underused.
The American Lung Association’s 2025 report estimated that only 18.2% of people at high risk nationwide received lung cancer screening.
Reasons may include:
Lack of awareness
Uncertainty about pack-year history
Confusion about eligibility after quitting
Insurance or cost concerns
Limited access to screening centers
Fear of receiving a cancer diagnosis
Smoking-related stigma
Clinicians not raising the subject
Competing health problems or appointments
Improving screening will require more than telling patients to ask for a scan. Healthcare systems also need better smoking-history records, referral processes, patient education, and access to experienced screening programs.
Smoking, Stigma, and Quitting Support
Nicotine dependence is a medical condition, not a character flaw.
People who smoke deserve evidence-based treatment and respectful healthcare—not blame.
Continuing to smoke does not make someone unworthy of a screening discussion. At the same time, screening is not a substitute for quitting.
Stopping smoking reduces future health risks at any age. Counseling and medications together generally give people the best chance of quitting successfully. FDA-approved options include nicotine-replacement products and prescription medications.
People who have never smoked can also develop lung cancer. The CDC estimates that about 10% to 20% of lung cancers in the United States occur in people who never smoked or smoked fewer than 100 cigarettes during their lifetime. Current population screening guidelines, however, are still mainly based on age and cigarette-smoking history.
What Denise Lee’s Story Can—and Cannot—Teach Us
Denise’s experience shows that:
Public-awareness campaigns can prompt people to take action
Screening can find some lung cancers before symptoms begin
Former smokers should not assume their risk disappeared immediately after quitting
Understanding eligibility can open the door to a useful medical conversation
An abnormal screening result requires diagnostic follow-up
Her story does not prove that:
Every eligible person has lung cancer
Every cancer will be found at an early stage
Screening guarantees survival
A billboard can replace medical advice
Every former smoker qualifies
Every lung nodule is cancer
Her story is one person’s experience. The broader lesson is to understand your risk and make a decision with a qualified healthcare professional.
What to Do Next
Estimate your pack-year history. Multiply the average number of packs smoked each day by the number of years smoked.
Review your age and smoking history. Include the date you quit, even if it was many years ago.
Ask your healthcare provider about LDCT. Discuss both the possible benefits and the possible harms.
Check your insurance or Medicare coverage. Ask about screening eligibility, participating facilities, prior authorization, and costs for follow-up testing.
Use an experienced screening program. Look for a facility that uses standardized nodule reporting and has a clear follow-up process.
Do not wait for screening if you have symptoms. Contact a healthcare professional for diagnostic evaluation.
Ask for quitting support when needed. Counseling, quitlines, and medications can improve the chance of success.
Questions to Ask Your Healthcare Provider
Do I meet current lung cancer screening criteria?
What is my pack-year history?
Does the number of years since I quit affect my eligibility?
Will my insurance cover the scan?
What are the benefits and risks for me?
Where should I have the LDCT performed?
What happens if the scan finds a nodule?
How often would I need screening?
When should screening stop?
What should I do if I develop symptoms?
Frequently Asked Questions
Who should be screened for lung cancer?
Guidelines commonly recommend annual LDCT for certain adults ages 50 through 80 who have at least a 20 pack-year smoking history. Rules concerning years since quitting, overall health, and insurance coverage can differ.
What is a low-dose CT scan?
A low-dose CT scan uses X-rays and computer processing to create detailed images of the lungs. It uses less radiation than a standard diagnostic CT but more radiation than a chest X-ray.
What does a 20 pack-year smoking history mean?
It may mean smoking one pack per day for 20 years, two packs per day for 10 years, or half a pack per day for 40 years.
Can former smokers qualify for screening?
Yes. Many former smokers qualify. The answer depends on age, pack-year history, health, the guideline being used, and sometimes how many years have passed since quitting.
Does Medicare cover lung cancer screening?
Medicare Part B covers annual LDCT screening for qualifying beneficiaries ages 50 through 77 who have at least a 20 pack-year history, currently smoke or quit within 15 years, have no lung cancer symptoms, and meet the other coverage requirements.
Is a chest X-ray used for lung cancer screening?
No. Current recommendations call for low-dose CT, not a chest X-ray, for lung cancer screening in eligible high-risk adults.
Can someone who never smoked develop lung cancer?
Yes. Lung cancer can occur in people who never smoked. Known risk factors include radon, secondhand smoke, certain workplace exposures, air pollution, and genetic factors. Some cases occur without a clear cause.
What are the risks of screening?
Risks include false-positive results, additional testing, radiation exposure, anxiety, incidental findings, overdiagnosis, and complications from unnecessary procedures.
What happens if the scan finds a nodule?
Most nodules are not cancer. Depending on the nodule’s features, the care team may compare older scans, repeat the scan later, order additional imaging, or recommend specialist evaluation or biopsy.
Should someone with symptoms ask for screening?
Symptoms usually require diagnostic evaluation rather than routine screening. Contact a healthcare provider instead of waiting to learn whether you meet screening criteria.
Final Takeaway
Denise Lee’s billboard was valuable because it started a conversation. The scan that followed found a tumor before she had symptoms, but her experience was personal—not a guarantee of what screening will find for someone else.
The practical next step is simple: calculate your pack-year history, write down when you quit, and ask your healthcare provider whether low-dose CT screening is appropriate for you.
References
Shultz, Cara Lynn. “A Billboard Saved Me from Dying from Lung Cancer—Before I
GO2 for Lung Cancer. “Survivor Spotlight: Denise Lee.” Accessed July 23, 2026.
Roche Diagnostics. “Denise’s Story: A Lung Cancer Survivor.” November 20, 2023.
U.S. Preventive Services Task Force. “Lung Cancer: Screening.” March 9, 2021.
National Cancer Institute. “Lung Cancer Screening—Patient Version.” Updated May 24, 2024.
Centers for Disease Control and Prevention. “How to Quit Smoking.” Updated May 15, 2024.
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This blog was reviewed by Dr. Sourabh Kharait.
This blog is for educational purposes only and is not intended as medical advice. Always consult with your healthcare provider before making any changes to your treatment plan, hydration strategies, or diet. The information provided here is based on general insights and may not apply to individual circumstances.
