Eligibility for Lung Cancer Screening Among Women With a Smoking History Undergoing Breast Cancer Screening

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In a single-center retrospective cohort study reported in JAMA Network Open, Titan et al identified the proportion of women with a history of smoking undergoing breast cancer screening with mammography who were eligible for low-dose computed tomography (CT) lung cancer screening, as well as the proportion who underwent lung cancer screening.

Study Details

The study included 874 women aged 55 to 74 years (mean = 66.8 years) with a history of smoking who underwent breast cancer screening at Stanford University Hospital between January 2019 and June 2020. Eligibility for lung cancer screening was determined using the 2013 U.S. Preventive Services Task Force (USPSTF) criteria.

Key Findings

Among the 874 women who underwent breast cancer screening, 99 (11.3%) were eligible for lung cancer screening; of these women, 35 (35.5%) underwent lung cancer screening. Chest CT was performed for other reasons in 28.3% of the 99 eligible women and 39.1% of the 775 ineligible women.     

A diagnosis of lung cancer was made in 6 eligible women (6.1%) and in 19 ineligible women (2.5%; P = .02). Disease was stage I in 4 of 6 eligible women and in 14 of 19 ineligible women. 

In an analysis using eligibility according to the updated 2021 USPSTF criteria (including high-risk individuals aged 50 to 80 years with a smoking history of ≥ 20 pack-years, current smokers, and those who quit within the past 15 years), lung cancer was diagnosed in 8.0% of eligible women vs 1.8% of ineligible women (P = .007). 

Cancer screening was ordered by primary care physicians for 82.6% of women eligible for breast cancer screening and for 60.0% of women eligible for lung cancer screening (P < .001).

The investigators stated: “Despite being proven to decrease mortality, lung cancer screening is underused among eligible women, in contrast to breast and colorectal cancer screening. Identifying women eligible for lung cancer screening during their breast cancer screening could increase detection rates and potentially at an earlier stage. This finding is consistent with previous literature and highlights the potential benefit of pairing breast cancer screening with effective strategies for lung cancer screening.”

Ashley L. Titan, MD, of the Department of Surgery, Stanford University Hospital, is the corresponding author of the JAMA Network Open article.

Disclosure: For full disclosures of the study authors, visit

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