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55% of NSCLC patients can still recur after curative-intent treatment. 🎯 That number should stop every radiologist and oncologist cold when they see a new nodule in a survivor.
According to BioSpace, published studies report recurrence rates of approximately 20% to 55% for non-small cell lung cancer, depending on stage, treatment and other factors. And the National Cancer Institute estimates 230,000 new lung cancer diagnoses in 2026 alone, added to the more than 680,000 Americans already living with a prior lung cancer diagnosis as of January 1, 2025.
That is a massive and growing surveillance burden. And most teams do not have a clean protocol for the hardest question: when a new nodule appears on post-treatment imaging, what does it actually mean?
Here is the framework I think every multidisciplinary team should have on the wall.
The Post-Treatment Nodule Decision Framework
Five questions. In order. Every time.
🔹 Step 1: Establish treatment context first. What was the original stage, treatment modality, and time since completion? A nodule at 4 months post-surgery carries different weight than one at 36 months post-radiation.
🔹 Step 2: Characterize the nodule against the post-treatment baseline. Is this new compared to the first post-treatment scan, or has it been stable and is now changing? Stability over 24 months shifts the probability significantly.
🔹 Step 3: Apply the three-way differential out loud. According to BioSpace, imaging alone cannot tell you if a new pulmonary nodule is recurrent cancer, a new cancer, or benign post-treatment changes including fibrosis, scarring, and treatment-related inflammation. Name all three possibilities explicitly before anchoring on any one.
🔹 Step 4: Assess patient risk tolerance and functional status. An invasive biopsy is not always the right next step. Some patients are appropriate for continued surveillance. Others need immediate tissue. That decision must be individualized.
🔹 Step 5: Trigger multidisciplinary review before the patient leaves the system. The worst outcome is a nodule flagged on imaging that falls through the cracks between radiology, oncology, and primary care.
Here is the contrast that matters most.
New nodule in a treatment-naive patient: the workup is relatively standardized.
New nodule in a lung cancer survivor: the differential is wider, the stakes are higher, and the imaging findings are harder to interpret.
Post-treatment tissue changes can mimic recurrence for years. That is the clinical trap.
Save this framework and share it at your next tumor board. It is the kind of reference that changes how your team runs the conversation, not just the individual case.
The 680,000 Americans living after a lung cancer diagnosis deserve a system that does not treat their follow-up as routine. Their nodules are not routine.
👉 Follow Jonathan Govette, CEO of Oatmeal Health, for daily healthcare insights on LinkedIn. Deeper dives in The Oatmeal Bite on Substack: https://news.oatmealhealth.com
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Author:
CEO/Co-Founder @ Oatmeal Health | AI Lung Cancer Screening | Almost Became a Doctor | Engineer | Follow to Share What I’ve Learned Along the Way
I help patients get the care they need earlier, preventing late-stage cancer.
That’s been the throughline across three companies and almost 20 years in healthcare. At ReferralMD, we fixed broken referral networks so patients didn’t fall through the cracks. At Oatmeal Health, it’s lung cancer: building the diagnostic and screening infrastructure so the 85% of cases caught too late get caught early instead.
Today as CEO of Oatmeal Health, I lead a team embedding AI into radiology workflows to turn routine lung CT scans into reimbursable cancer risk assessments. We partner with FQHCs to reach underserved communities, and with health systems and payers to make early detection economically sustainable. Think HeartFlow or Cleerly, but for lungs.
Between companies, I advised at Techstars and Plug and Play, mentoring founders building in digital health. That experience shaped how I think about what separates companies that ship from companies that stall: distribution, reimbursement, and clinical trust, not just technology.
I’m a CancerX alumnus, a 3x healthcare founder, and someone who believes the biggest problems in cancer aren’t scientific. They’re operational.
We’re hiring mission-driven builders at Oatmeal Health. If you want to work on something that matters, reach out.
When I’m not working, I’m traveling, mentoring, and keeping up with one very energetic husky. 🐾
Substack – The Oatmeal Bite:
Millions of patients get less care because of who they are, where they live, or how they look. I’m fighting to change that. CEO @OatmealHealth, a startup built for the underserved. The Oatmeal Bite: intel for clinicians, investors, and advocates.
Jonathan Govette
CEO of Oatmeal Health
Substack:
https://oatmealhealthjonathangovette.substack.com/
