In a study reported as a research letter in JAMA, Bandi et al compared estimated deaths prevented and life-years gained with current uptake vs 100% uptake of annual lung cancer screening in eligible U.S. individuals.
Study Details
The study used data obtained from the 2024 National Health Interview Survey (population-based household survey of noninstitutionalized civilians), with a response rate of 47.9%. Among individuals aged 50 to 80 years without lung cancer who ever smoked, the weighted prevalence of up-to-date lung cancer screening (self-report of past-year receipt of screening computed tomography) was estimated for screening-eligible individuals based on the U.S. Preventive Services Task Force 2021 criteria of current smoking or < 15 years since quitting with a history of ≥ 20 pack-years.
Models were used to estimate lung cancer deaths preventable by screening over 5 years and life-years gained from screening. The models assumed that lung cancer screening prevented 20.4% of lung cancer deaths with three annual screens based on the National Lung Cancer Screening Trial results. Outcomes were estimated for current uptake level among screening-eligible individuals, 100% uptake among unscreened screening-eligible individuals, and 100% uptake in screening-ineligible individuals with ever-history of smoking. Analyses were weighted to be nationally representative.
Key Findings
Among the individuals included in the analysis, 2,124 (31.2%) were eligible for screening, representing a weighted total of 12.76 million individuals (66.4% aged ≥ 60 years). An additional 4,390 individuals, representing a population of 28.08 million, were screening-ineligible; of these, 18.1% had at least 15 years since quitting and at least 20 pack-years of smoking.
Among screening-eligible individuals, 18.7% reported up-to-date lung cancer screening. The prevalence of up-to-date screening was higher in individuals aged 60 years or older (eg, 7.9% among those aged 50 to 54 years vs 22.8% among those aged 70 to 80 years) and higher among individuals with increased comorbidities (eg, 28.1% for those with three or more comorbidities vs 9.6% for those with none).
Among screening-eligible individuals, 100% screening uptake was estimated to prevent a weighted value of 62,110 lung cancer deaths over 5 years with a gain of 872,270 life-years. Current up-to-date lung cancer screening uptake was estimated to prevent 24% (weighted n = 14,970) of these deaths, with a 22% gain in life-years (weighted n = 190,030 life-years).
For each additional 1,000 eligible individuals who underwent screening, it was estimated that life-years gained among those with one, two, or three or more comorbidities were similar (65.3, 61.6, and 64.1 years, respectively), despite an increase in prevented deaths (4.1, 4.3, and 5.6 deaths, respectively).
Over 5 years, 100% screening uptake among screening-ineligible ever-smokers would yield prevention of an estimated 29,690 additional deaths and gain of an estimated 482,410 additional life-years.
Overall, an estimated 64% of deaths averted would occur in two groups of individuals: former smokers with at least 15 years since quitting and a history of at least 20 pack-years, and current smokers with a history of at least 20 pack-years.
The investigators concluded: “Only approximately one in five eligible individuals in the United States underwent lung cancer screening in 2024. Increasing current uptake to 100% could increase deaths prevented and life-years gained threefold.”
Priti Bandi, PhD, of Surveillance, Prevention, & Health Services Research, American Cancer Society, Atlanta, is the corresponding author for the JAMA article.
Disclosure: The study was funded by the American Cancer Society Intramural Research Department. For full disclosures of all study authors, visit jamanetwork.com.
