Researchers at Northwestern Medicine have raised concerns about the effectiveness of current lung cancer screening guidelines, arguing that they fail to catch most patients. The study, published in JAMA Network Open, analyzed nearly 1,000 patients treated at the institution between 2018 and 2023, revealing that only 35% of those diagnosed would have qualified for screening under existing criteria set by the U.S. Preventive Services Task Force (USPSTF). These guidelines prioritize annual CT scans for individuals aged 50 to 80 with a significant smoking history, such as those who smoked one pack per day for 20 years or quit within the last 15 years. The remaining 65% of patients—many of whom are non-smokers, women, or individuals of Asian descent—would not have been flagged for early detection before their diagnosis.
According to the study, the current approach misses a substantial number of high-risk patients, particularly those with adenocarcinoma, the most common type of lung cancer among never-smokers. Patients who did not meet the screening criteria lived significantly longer—9.5 years on average—compared to those who qualified, who survived only 4.4 years. While the difference in survival rates may partly reflect variations in tumor biology and earlier detection, the researchers argue that it underscores the limitations of the current system in identifying a broader range of cases that could be treated sooner.
The researchers propose a shift toward universal age-based screening, covering individuals aged 40 to 85, regardless of their smoking history. This model could detect 94% of the cancers in their cohort, potentially saving 26,000 lives annually at a cost of approximately $101,000 per life saved. Despite these promising projections, the study acknowledges limitations, including a focus on a single academic center and reliance on historical data rather than real-world screening outcomes. Additionally, the cost and mortality estimates depend on assumptions about how screening would be implemented, and the researchers noted that potential downsides—such as false positives or unnecessary follow-ups—are not fully accounted for.
Dr. Luis Herrera, a thoracic surgeon at Orlando Health, emphasized the need for greater awareness and accessibility of lung cancer screening. He pointed out that many insurance plans cover the cost, and discounts are often available for patients without coverage. However, Herrera noted the challenges in adoption, including low awareness of the screening program and some providers not recommending it. As lung cancer remains the deadliest form of cancer in the U.S.—killing more people annually than colon, prostate, and breast cancers combined—expanding screening criteria may be a critical step in improving early detection, particularly for underrepresented and vulnerable groups.