BACKGROUND AND PURPOSE:

• The US Preventive Services Task Force (USPSTF) currently recommends lung cancer screening with low-dose computed tomography for adults >50 years with a history of smoking
  • Lung cancer rates among never smokers are increasing, suggesting that the current recommendations may exclude some at-risk populations
• Yang et al. (JAMA Network Open, 2025) evaluated the proportion of patients with lung cancer who meet or are excluded from USPSTF criteria 

METHODS:

• Retrospective cohort study
  • Data derived from electronic medical records at Northwestern University, Chicago
• Population
  • Individuals with lung cancer diagnosed between 2018 and 2023
  • Individuals were stratified by 2021 USPSTF eligibility
    • Age 50 to 80 | ≥20 pack-years | Current or quit <15 years
• Exposure
  • Diagnosis of lung cancer
• Study design
  • Group comparisons were performed using Pearson χ2 or Fisher exact tests for categorical variables and Wilcoxon rank-sum tests for continuous variables
  • Cox proportional hazards models were used to calculate hazard ratios
• Primary outcome
  • Proportion of patients meeting USPSTF criteria
• Secondary outcomes
  • Survival
  • Clinical characteristics
  • Impact of expanded screening scenarios on detection, cost-effectiveness, risk

RESULTS:

• 997 patients
  • Median age: 67 (IQR, 18 to 99) | Women: 58.0%
  • Met USPSTF criteria: 35.1%
• The individuals that did not meet USPSTF criteria included
  • More women
    • Met criteria: 52.0% women | Did not meet criteria: 61.0% women
  • More Asian patients
    • Met criteria: 3.7% Asian | Did not meet criteria: 9.6% Asian
  • More never smokers
    • Met criteria: 0% | Did not meet criteria: 38.0%
  • More individuals with adenocarcinoma diagnoses
    • Met criteria: 55.0% | Did not meet criteria: 72.0%
• Individuals who did not meet screening criteria were more likely to have better survival outcomes
  • Met criteria: median 4.4 (IQR, 3.7 to 6.0) years
  • Did not meet criteria: median 9.5 (IQR, 6. 6 to 12.3) years
  • Hazard ratio (HR) 0.67 (95% CI, 0.55 to 0.82) | P<0.001
• Reasons for screening eligibility among ineligible patients with lung cancer
  • Never smoker: 24.8%
  • Quit longer than 15 years: 13.0%
  • <20 pack-years: 6.5%
  • Aged outside 50 to 80 rang: 4.1%
• Detection would improve to 62.1% if criteria were expanded to include
  • Age 40 to 85 years
  • ≥10 pack-years
  • No cessation limit
• The modeled age-based screening (40 to 85 years) detected 93.9% of cases
  • Deaths prevented annually: 26,124 (95% CI, 20,000 to 32,248)
  • Cost per life saved: $101,000 (95% CI, 82,000 to 120,000)
• The cost of screening per life saved was lower for the modeled lung cancer screening, compared to breast cancer screening or colorectal cancer screening
  • Breast cancer: $890,000 (95% CI, $700,000 to $1,100,000)
  • Colorectal cancer: $920,000 (95% CI, $700,000 to $1,200,000)
• Additional analysis confirmed robust findings across all parameter ranges
  • Probability of superior cost-effectiveness: 98.7%

CONCLUSION:

• Current USPSTF lung cancer screening guidelines exclude many patients who go on to be diagnosed with lung cancer
  • This excluded group is disproportionately female and never-smokers
• The authors state

Current USPSTF guidelines missed nearly two-thirds of cases, disproportionately excluding women, individuals from minoritized racial and ethnic groups, and never-smokers with favorable prognoses

Age-based screening (40-85 years) could enhance detection to 93.9%, prevent 26 124 deaths annually, and prove 6-fold more cost-effective than existing cancer screening programs

Learn More – Primary Sources:

Age-Based Screening for Lung Cancer Surveillance in the US