The researchers emphasized that the current eligibility criteria for lung cancer screening, which are based primarily on smoking history, are too narrow and may exclude millions of Americans at risk. The study, conducted at a single academic center, found that patients who didn’t meet the criteria had better survival outcomes, although this was partially attributed to earlier detection and differences in tumor biology. Herrera pointed out that the low participation in screening among those who qualify is likely due to the complexity of the risk-based criteria and the stigma associated with smoking and lung cancer.
The researchers proposed a universal age-based screening approach, which would include all individuals between the ages of 40 and 85, regardless of smoking history. Under this model, the study estimated that about 94% of the cancers in their cohort would have been detected. This approach could prevent approximately 26,000 U.S. deaths each year, at a cost of about $101,000 per life saved. The study also noted that this would be more cost-effective than current screening programs for breast or colorectal cancer, which cost significantly more per life saved.
Despite the potential benefits, Herrera acknowledged several challenges in implementing this broader screening strategy, including lack of awareness, provider reluctance, and the potential downsides of broader screening, such as false positives or unnecessary follow-ups. He also highlighted that the cost of screening is generally covered by most health insurance plans, with many institutions offering discounts for patients without insurance. The researchers emphasized that expanding screening to include all adults within an age range could help close gaps in detection, particularly for underrepresented groups. However, they also acknowledged the need for further research to validate how the new model would perform in real-world screening programs.