AGE-BASED lung cancer screening could detect far more cases than current US risk-based eligibility criteria.
Current Guideline Criteria Miss Most Patients
In this single center cohort of 997 adults with lung cancer diagnosed between 2018 and 2023, only 35.1% met current US Preventive Services Task Force criteria for lung cancer screening with low dose CT. Eligible patients were more likely to be male, White, heavier smokers and to have worse survival, with median survival of 4.4 years compared with 9.5 years in those who would not have qualified for screening. Patients outside guideline criteria included a higher proportion of women, Asian patients, never smokers, people with lower pack year exposure and those with adenocarcinoma histology.
Never smokers accounted for nearly one quarter of all lung cancer cases, and substantial numbers of cancers occurred in people who had quit more than 15 years earlier or had smoked fewer than twenty pack-years. Patients outside the guideline age band of 50 to 80 years also developed lung cancer yet were not eligible for low dose CT surveillance, underscoring the limitations of age and smoking history-based criteria.
Age-Based Lung Cancer Screening and Detection
The investigators modeled several expanded eligibility scenarios using institutional and published data. Broadening criteria to ages 40 to 85 years, at least ten pack-years of smoking and no upper limit on time since cessation increased the proportion of screen detectable cancers to 62.1%, yet still left almost four in ten patients outside the net. In contrast, an age-based lung cancer screening approach that offered low dose CT to all adults aged 40 to 85 years captured 93.9% of cancers.
Cost Effectiveness and Equity Implications
Age-based lung cancer screening was associated with an estimated 26,124 deaths prevented annually in the US and a cost of 101,000 USD per life saved, which was around six times more cost effective than existing national screening programs for breast cancer screening and colorectal cancer screening. Sensitivity analyses suggested a very high probability, 98.7%, that age-based strategies remained cost effective across a broad range of assumptions. The authors conclude that shifting from strict smoking history thresholds toward age focused lung cancer screening could improve early detection, narrow disparities for women and never smokers and provide better value for health systems.
Reference: Yang HC et al. Age-Based Screening for Lung Cancer Surveillance in the US. JAMA Netw Open. 2025;8(11):e2546222.
