Lung cancer screening guidelines miss 65% of patients, study finds

A new study from Northwestern Medicine suggests that current lung cancer screening guidelines may be missing most Americans who develop the disease — and researchers say it’s time for a major change.

Published in JAMA Network Open, the study analyzed nearly 1,000 lung cancer patients who were treated at Northwestern Medicine between 2018 and 2023. 

The goal was to see how many of those patients would have qualified for screening under existing guidance from the U.S. Preventive Services Task Force (USPSTF).

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USPSTF currently recommends annual CT scans for adults ages 50 to 80 who have a 20 pack-year smoking history (the equivalent of one pack of cigarettes per day for 20 years) and either still smoke or quit within the last 15 years.

Only about 35% of those diagnosed with lung cancer met the current criteria to undergo screenings.

That means roughly two-thirds of patients would not have been flagged for testing before their diagnosis.

“Not only does that approach miss many patients who had quit smoking in the past or did not quite meet the high-risk criteria, it also misses other patients at risk of lung cancer, such as non-smokers,” Luis Herrera, M.D., a thoracic surgeon at Orlando Health, told Fox News Digital.

The study noted that these patients tended to have adenocarcinoma, the most common type of lung cancer among never-smokers.

Those missed by the guidelines were more often women, people of Asian descent and individuals who had never smoked, the study found.

The research team also compared survival outcomes. Patients who didn’t meet the screening criteria had better survival, living a median of 9.5 years compared with 4.4 years for those who did qualify. 

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While this difference partly reflects tumor biology and earlier detection, it also highlights how current screening rules fail to catch a broad range of cases that could be treated sooner, according to researchers.

“The current participation in lung cancer screening for patients who do qualify based on smoking history is quite low,” said Herrera, who was not involved in the study. This is likely due to the complexity of the risk-based criteria and stigma associated with smoking and lung cancer, he added.

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To test an alternative, the researchers modeled a different approach: screening everyone between the ages of 40 and 85, regardless of smoking history. 

Under that universal, age-based model, about 94% of the cancers in their cohort would have been detected.

Such a change could prevent roughly 26,000 U.S. deaths each year, at a cost of about $101,000 per life saved, according to their estimates. 

The study emphasized that this would be far more cost-effective than current screening programs for breast or colorectal cancer, which cost between $890,000 and $920,000 per life saved.

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Herrera noted the many challenges in the adoption of lung cancer screening, from lack of awareness to some providers not recommending the screening test.

However, he added, “The cost of screening is covered by most health insurance plans and many institutions also offer discounts for patients who don’t have insurance.”

“The current participation in lung cancer screening for patients who do qualify based on smoking history is quite low.”

Lung cancer remains the deadliest cancer in the country, killing more people each year than colon, prostate and breast cancer combined. But because of the narrow eligibility criteria based on smoking history, millions at risk never get screened.

Northwestern Medicine researchers argue that expanding screening to include all adults within an age range could help close those gaps, especially for groups often underdiagnosed.

The study was conducted at a single academic center, which means the patient population may not represent the wider U.S. population. It also looked back at existing data, so it can’t prove how the new model would perform in real-world screening programs, the researchers acknowledged.

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The cost and mortality projections rely on assumptions that could shift depending on how screening is implemented. 

The researchers also didn’t fully account for the potential downsides of broader screening, such as false positives or unnecessary follow-ups, they noted.

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For patients who don’t qualify for lung cancer screening, there are other opportunities for lung evaluations, including “heart calcium scores, CT scans and other imaging modalities that can at least evaluate the lungs for any suspicious nodules,” Herrera added.