Abstract
Lung cancer remains the leading cause of cancer-related mortality globally and is often diagnosed at advanced stages in Saudi Arabia. This cross-sectional study aimed to quantify public awareness and knowledge of lung cancer screening (LCS) using LDCT and identify barriers to its implementation in Riyadh. A validated 24-item questionnaire was administered to 452 participants to assess demographic factors, smoking history, and LCS knowledge. Results revealed that only 30.1% of participants had heard of LCS, and 50.2% demonstrated "poor" knowledge scores (mean score 11.0 ± 4.97). Higher knowledge scores were significantly associated with being female, having a bachelor's degree or higher, and being a non-smoker. While 78.1% expressed willingness to undergo screening, the most significant barrier was a lack of knowledge about the test (44.1%), followed by concerns regarding radiation exposure (36.1%). Conversely, a healthcare provider's recommendation was identified as the primary motivator for 53.3% of respondents. These findings highlight a critical "awareness-willingness" gap. While public willingness is high, this should not be misconstrued as systemic preparedness; substantial educational and structural gaps remain that must be bridged before national implementation can be considered feasible. We conclude that while public willingness is high, successful implementation requires a transition toward organized invitation systems and the use of multifactorial risk profiles. Integrating epidemiological evidence with proactive policy design is essential to ensure that the national program avoids systematic under- or over-inclusion and remains effective for all demographics.