Hee Chul Yang, Austin Chang, Maxime Visa, et al. JAMA Netw Open. 2025 Nov 3;8(11):e2546222
Lung cancer is increasingly diagnosed in never-smokers, suggesting that the current US Preventive Services Task Force (USPSTF) screening criteria using low-dose computed tomography exclude many at-risk individuals, thus raising concerns about their effectiveness and equity. Patients with lung cancer diagnosed from 2018 to 2023 at an academic center were analyzed, with follow-up through 2024. Among 997 patients, age, 67 years; 577 [58.0%] women), only 350 (35.1%) met USPSTF criteria. The nonguideline group included more women (396 of 647 patients vs 181 of 350 patients), Asian patients (62 of 647 patients vs 13 of 350 patients), and never-smokers (247 of 647 patients); had more adenocarcinoma diagnoses (469 of 647 patients vs 192 of 350 patients); and had better overall survival (median, 9.5 vs 4.4 years; HR, 0.67; P < .001) than the guideline group. Never-smokers (247 of 997 patients), those who quit longer than 15 years (134 of 997 patients), those with less than 20 pack-years (65 of 997 patients), and those aged outside the 50 to 80 year range (41 of 997 patients) were excluded. Expanding criteria to age 40 to 85 years, 10 or more pack-years, and no cessation limit increased detection to 62.1% (619 of 997 patients). A modeled age-based screening (40-85 years) captured 93.9% of cases (936 of 997 patients) and prevented 26,124 deaths annually at $101 000 per life saved, compared with $890 000 for breast cancer and $920 000 for colorectal cancer screening. Current USPSTF guidelines exclude two-thirds of patients, disproportionately women and never-smokers. Age-based screening substantially improved detection demonstrated 6-fold superior cost-effectiveness compared with existing programs and addressed inequities.
13 May, 2026