A new study published in JAMA Network Open by researchers at Northwestern Medicine has revealed that current U.S. lung cancer screening guidelines fail to identify about 65% of patients. This finding highlights a significant gap in the existing criteria, which rely primarily on smoking history and age rather than a universal approach. The study analyzed nearly 1,000 lung cancer patients treated at the institution between 2018 and 2023, revealing that only about 35% of them would have qualified under the current U.S. Preventive Services Task Force (USPSTF) guidelines. This means roughly two-thirds of patients would not have been flagged for testing before their diagnosis.
The researchers emphasize that the current approach overlooks a substantial number of patients, particularly those who have quit smoking or do not meet high-risk criteria, as well as non-smokers. These patients are more likely to have adenocarcinoma, the most common type of lung cancer among individuals who never smoked. The study also notes that missed patients tend to be more often women, people of Asian descent, and individuals who had never smoked. Additionally, the survival rates for patients who didn’t meet the screening criteria were significantly higher, with a median survival of 9.5 years compared to 4.4 years for those who did qualify.
While part of this survival difference may be due to tumor biology and earlier detection, the researchers argue that it highlights the shortcomings of the current screening system. Luis Herrera, a thoracic surgeon at Orlando Health, stated that the current participation in lung cancer screening for patients who qualify based on smoking history is quite low. This is likely due to the complexity of the risk-based criteria and the stigma associated with smoking and lung cancer. The study then proposes an alternative approach: screening everyone between the ages of 40 and 85, regardless of smoking history. Under this model, the researchers estimate that 94% of cancers in the studied cohort would have been detected.
Such a change could prevent roughly 26,000 U.S. deaths annually, at an estimated cost of $101,000 per life saved. The researchers also note that this model would be far more cost-effective compared to current programs for breast or colorectal cancer, which cost significantly more per life saved. However, Herrera acknowledged the many challenges in implementing this strategy, including a lack of awareness and reluctance from some providers to recommend the screening test.
Lung cancer remains the deadliest cancer in the country, killing more people annually than colon, prostate, and breast cancer combined. The narrow criteria based on smoking history means millions at risk never get screened. The researchers argue that expanding screening to include all adults within an age range could help close these gaps, particularly for underdiagnosed groups. However, they also note that the study was conducted at a single academic center, so the results may not be representative of the wider U.S. population. Additionally, the analysis relied on existing data, meaning it cannot conclusively determine the effectiveness of the new model in real-world screening programs.
Researchers emphasized that the cost and mortality projections depend on assumptions that could shift depending on how screening is implemented. They also highlighted the potential downsides of broader screening, such as false positives and unnecessary follow-ups, which were not fully accounted for in their analysis. For patients who don’t qualify for lung cancer screening, other opportunities exist for lung evaluations, including heart calcium scores, CT scans, and other imaging modalities that can assess for suspicious nodules. Herrera urged healthcare providers and patients to consider these alternative diagnostic tools, emphasizing the importance of early detection and comprehensive care.