JAMA Netw Open

Could biennial lung screening be sufficient for younger, moderate-risk patients?

July 29, 2025

For moderate-risk individuals (especially those <60 years or <30 pack-years), biennial CT screening maintains nearly all mortality benefit of annual screening with fewer scans and lower costs. Adaptive intervals may be preferable in resource-constrained settings or for lower-risk subgroups.

Study details: This economic evaluation used three microsimulation models to assess health outcomes and costs of adaptive low-dose CT screening intervals in the U.S. 1965 birth cohort, stratified by age, sex, and smoking history (10–20, 20–30, ≥30 pack-years). Simulated cohorts (n = 200,000 per stratum) were followed from 2005–2065, with screening eligibility per 2021 USPSTF criteria. Effectiveness was measured by lung cancer deaths prevented and life-years gained; burden by number of CT screens; and cost-effectiveness by QALYs gained and a $100,000/QALY threshold.

Results: Initiating biennial screening at ages 50–60, then switching to annual, preserved 95.9% (range, 93.5–97.5%) of lung cancer deaths prevented compared with annual screening, while reducing CT screens by 20.6% (range, 19.3–21.9%). Annual screening from 50–80 years wasn't cost-effective. All cost-effective strategies began with biennial screening, escalating to annual at age 60 or at higher pack-year thresholds.

Source:

de Nijs K, et al. (2025, July 1). JAMA Netw Open. Computed Tomographic Screening Intervals for Patients at Moderate Risk of Lung Cancer. https://pubmed.ncbi.nlm.nih.gov/40705331/