Office of Research & Development |
  |
L-R: Dr. Katarina Wrzos, associate director; Dr. Anne Melzer, medical director; and Jaclyn Schaefer, RN, lung cancer screening coordinator, of the lung cancer screening program at the Minneapolis VA Health Care System. Photo: Minneapolis VA Health Care System
August 28, 2026
By Marcus Henry
VA Research Communications
No news is not good news. It just means we don’t know yet. And if it’s been too long, we need to look into it. (Jaclyn Schaefer, RN)
Lung cancer kills more Veterans than any other cancer, and the surest way to change that is to find it early, while a suspicious spot on a scan is still small enough to cut out or irradiate and be done. But for rural Veterans, the scan was never the hard part. The follow-up was.
For years, a Veteran who lived hours from a VA medical center could get screened close to home, in the community, and then watch the results disappear into a gap. The images came back to a primary care provider who was left to read them alone, often without the Veteran’s earlier VA scans to compare against. Some Veterans went straight to an outside pulmonologist who had none of their records. Some got worked up for nodules that never needed it. Others waited on a finding that did.
“A missed or a dropped nodule loses us that advantage,” said Dr. Anne Melzer, a pulmonologist and researcher at the Minneapolis VA Health Care System who led the project. “We can lose weeks or months, where that cancer might grow or spread, and we have fewer treatment options.”
A VA team at Minneapolis set out to close that gap, and they did it without buying or building anything new. Working with the tools VA already had, they folded community-care screening back into the medical center’s centralized program: one place where every suspicious nodule gets reviewed by a pulmonologist, every result gets tracked, and every next step gets ordered on time. They called it a referral coordination initiative, and at its center they put a new position, a lung cancer screening referral coordinator and case manager, filled by Jaclyn Schaefer.
The results were dramatic: appropriate pulmonary consultation for high-risk nodules rose from 45% to 100%. The share of consults completed inside VA climbed from 11% to 88%. Results came back in about half the time, cutting roughly 28 days down to 14. And of more than 3,000 referrals in the first year, not one Veteran who was ineligible for screening got scanned anyway, a quiet number that means people were spared a test, and the risks, that would not have helped them.
Behind those figures is a job that looks a lot like air traffic control. Schaefer keeps a vetted list of community imaging sites that follow national radiology standards, chases down scans that are slow to return, and reads the pattern when one goes missing.
“No news is not good news,” she said. “It just means we don’t know yet. And if it’s been too long, we need to look into it.”
When a scan comes back clean, the Veteran hears back quickly. When it doesn’t, Schaefer moves. She has flagged small-cell cancers for primary care before the paperwork caught up, and stayed on the line with Veterans through biopsies, referrals, and the first frightening days after a diagnosis, making sure the hand-off to oncology or radiation or surgery happens.
The point was never to fix just Minneapolis though. According to Melzer, the initiative was deliberately designed for wide-scale implementation from the start. The team co-developed the screening program from scratch with the Sioux Falls VA, where about 70% of Veterans in the community are eligible for this care. From there it moved through the VA Midwest network. The VA in Fargo, ND, took the program on early. Even with few medical centers and Veterans spread across the state, often living six hours from care, they now screen rural Veterans at equitable rates across the Dakotas.
VA’s National Center for Lung Cancer Screening has since determined that all VA sites should incorporate community-care screening, and the Minneapolis team has spent the last year sharing what it learned with national stakeholders shaping that rollout. The work is built to last.
Melzer said she is clear-eyed about what needs to happen next: adapting it to VA’s new electronic health record and extending the same tracking discipline to incidental lung nodules, the ones found by accident on scans ordered for something else. The team also lends pulmonary e-consult support to sites in its network that have no pulmonologist of their own.
No matter the improvements to VA’s lung cancer program, the first step will always be a matter of convincing a Veteran to get the screening. Most times, that story looks like the experience of Ardell Lorenz. He spent four years in the Marine Corps, 1966 to 1970, repairing small arms through two tours in Vietnam. Then he went home to Rice Lake, Wisconsin, a town of about nine thousand, and stayed. On the police force for 16 years, then 19 more carrying rural mail. He is 79 now. The Minneapolis VA Medical Center is two hours away. The outreach clinic in town is ten minutes away, but it has no scanner.
For a couple of years his providers asked at his annual visit if he wanted the lung cancer scan. He finally said yes, and it came back clear. The next year the community-care piece did not come together in time, so he let it slide. The year after, he had it done again, but this time there was a spot. A six-month scan showed no change. Now he is on a yearly schedule, with the next one set for September.
He is not rattled by it. The spot is small, and no one is talking about a biopsy unless it grows. What stuck with him was how little the screen asked of him. Two minutes in the tube, no need to change clothes, and a week and a half later a letter from the VA telling him where things stand. Ask him what he would tell another Veteran who keeps putting it off, and he does not reach for anything.
“Get the screening done,” he said. “It’s a piece of cake. It takes longer to get there than it does for the scan.”
Schaefer said most Veterans have the same reaction as Lorenz. Once a doctor explains why the scan matters, they prepare themselves for a complicated process that turns out to be surprisingly simple.
“I tell patients this is the easiest screen you can do,” Schaefer said. “And afterward it’s always, that was so easy. Why didn’t I do it sooner?”
The study appeared in the Annals of the American Thoracic Society.
VA Research Currents archives || Sign up for VA Research updates
