Lung Cancer Screening Uptake Among Adults Newly Eligible Under the 2023 American Cancer Society Guideline Compared With USPSTF-Eligible Adults: A Nationwide Cross-Sectional Study.
Abstract
Background
The 2023 American Cancer Society (ACS) lung cancer screening (LCS) guideline expanded eligibility beyond the 2021 US Preventive Services Task Force (USPSTF) recommendations by removing the 15-year smoking cessation criterion. Screening uptake among adults newly eligible under ACS criteria remains unclear. RESEARCH QUESTION How does LCS uptake among adults newly eligible under the 2023 ACS criteria differ from uptake among adults eligible under the 2021 USPSTF criteria? STUDY
Design
AND
Methods
We analyzed 2024 National Health Interview Survey data for adults aged 50 to 80 years with a computable pack-year history, current or former smoking history, and no prior lung cancer diagnosis. Respondents were classified as USPSTF-eligible (≥20 pack-years, quit <15 years ago or currently smoke), ACS-only-eligible (≥20 pack-years, quit >15 years ago), or neither-eligible. Outcomes were past-12-month and any reported LCS. Survey-weighted multivariable logistic regression estimated associations between eligibility group and screening uptake.
Results
The analytic sample included 5,987 adults, representing approximately 37.5 million US adults with a smoking history. Overall, 35.2% were USPSTF-eligible, 13.5% ACS-only-eligible, and 51.2% neither-eligible. Past-12-month LCS prevalence was 17.8%, 8.0%, and 3.9%, respectively. Compared with neither-eligible adults, USPSTF eligibility was associated with higher odds of both past-12-month LCS (OR, 4.54; 95% CI, 3.44-5.98) and any reported LCS (OR, 3.44; 95% CI, 2.77-4.27). ACS-only eligibility was associated with higher odds of past-12-month LCS (OR, 1.62; 95% CI, 1.12-2.35) but not any reported LCS. Within the ACS-only group, non-Hispanic Black race and telehealth use were associated with higher screening uptake.
Interpretation
Adults newly captured by the 2023 ACS criteria showed measurable past-12-month LCS uptake, but uptake remained less than half that of USPSTF-eligible adults. These findings suggest early implementation of broader ACS eligibility, while highlighting the need for equity-focused, clinician- or system-triggered strategies to identify former smokers with remote quit history.