In a study reported in a research letter in JAMA Network Open, Henderson et al identified prevalence of lung cancer screening in the United States in 2022 using U.S. Preventive Services Task Force (USPSTF) 2021 and 2013 recommendations for screening eligibility.
The USPSTF 2013 guidelines recommended annual lung cancer screening for individuals aged 55 to 80 years who currently or formerly smoked (quit within 15 years) with a 30 pack-year smoking history. The 2021 guidelines recommended annual screening in individuals beginning at age 50 years with a 20 pack-year history, increasing the population of eligible individuals. As noted by the investigators, the changes were made in part to address concerns with eligibility disparities according to race/ethnicity and sex.
Study Details
The study used Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System (BRFSS) data for 2022, which included lung cancer screening data for all states. Individuals included in the analysis were aged 50 to 79 years with self-reported current smoking or quitting within the last 15 years with a ≥ 20 pack-year smoking history.
Key Findings
In 2022, the lung cancer screening–eligible population was 13,526,348 individuals on 2021 criteria and 8,154,440 using 2013 criteria—representing an increase of 5,371,908 individuals in the eligible population. Expansion of the eligibility criteria led to the greatest increases in eligibility among Asian (88% increase), Black (109% increase), and Hispanic (86% increase) individuals. The number of eligible females increased by 78%, compared with 57% for males.
In 2022, per 2021 criteria, 2,217,919 (16.4%) of 13,526,348 eligible individuals underwent lung cancer screening. In 2022, per 2013 criteria, 1,598,865 (19.6%) of 8,154,440 underwent lung cancer screening. A total of 619,054 additional individuals underwent screening using 2021 criteria.
In 2022, per 2021 and 2013 criteria:
- 100,884 (15.7%) of 641,116 (2021 criteria) and 78,596 (22.8%) of 345,218 (2013 criteria) Hispanic individuals underwent lung cancer screening
- 40,419 (23.1%) of 175,228 and 37,341 (40%) of 93,387 Asian individuals underwent lung cancer screening
- 194,921 (17.1%) of 1,138,680 and 98,468 (18.1%) of 544,449 Black individuals underwent lung cancer screening
- 1,755,951 (16.5%) of 10,617,578 and 1,301,241 (19.6%) of 6,626,844 White individuals underwent lung cancer screening
- 994,357 (16.1%) of 6,177,439 and 686,799 (19.8%) of 3,473,528 females underwent lung cancer screening
- 1,223,562 (16.6%) of 7,348,909 and 912,066 (19.5%) of 4,680,912 males underwent lung cancer screening.
Among individuals newly eligible for lung cancer screening under 2021 criteria, 2,063,840 were aged 50 to 54 years, with 6.1% undergoing lung cancer screening, and 4,020,879 individuals had a 20 to 29 pack-year smoking history, with 13.1% undergoing lung cancer screening.
On 2021 criteria, lung cancer screening prevalence estimates ranged from 8.6% in Wyoming to 28.7% in Rhode Island, with higher rates generally found in Northeastern and Mid-Atlantic states.
The investigators stated, “In this cross-sectional study, expanded USPSTF eligibility criteria were associated with 5,371,908 additional individuals eligible for [lung cancer screening], with relative increases highest for Asian, Black, Hispanic, and female individuals, aligning with the goal of reducing race and ethnic and sex disparities in eligibility…. While approximately 619,054 newly eligible individuals were screened under expanded recommendations, 2022 [lung cancer screening] prevalence remained low (16.4%). Prior BRFSS analyses using 2013 USPSTF criteria reported [lung cancer screening] prevalence rates of 12.8% in 2019 (20 states) … and 21.2% in 2021 (4 states), indicating a similar [lung cancer screening] prevalence rate in 2021 and 2022 (19.6%).”
Louise M. Henderson, PhD, of the Department of Radiology, University of North Carolina at Chapel Hill, is the corresponding author for the JAMA Network Open article.
Disclosure: The study was supported by grants from the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.
