JAMA Netw Open

Simplified lung cancer screening shows no drop in accuracy, may reduce disparities

June 26, 2025

Study details: This cohort study analyzed 43,521 individuals from lung cancer screening (LCS) and incidental pulmonary nodule (IPN) programs across a large community health system in the southern U.S. (2015–2023). Researchers compared standard USPSTF 2021 LCS criteria with alternative models: Potter (≥20 years smoking), ACS (≥20 pack-years, no quit-time limit), and combinations including 10-year thresholds.

Results: Of the 29,751 individuals in IPN programs, only 13% were eligible under USPSTF 2021 criteria, compared with 16% to 21% under expanded models. The Potter criteria alone identified 1,103 additional eligible individuals—55% female and 35% Black—compared with USPSTF’s 48% and 22%, respectively (P < .001). Lung cancer detection rates remained high (17% to 18%) across expanded criteria. Notably, a 10-year smoking history threshold would have made 27% of IPN patients eligible, with a 16% cancer diagnosis rate.

Clinical impact: Relaxing smoking exposure criteria—especially by using years smoked rather than pack-years—markedly improves access to LCS for historically underrepresented groups while maintaining diagnostic efficiency. These findings support revising LCS guidelines to reduce disparities and enhance early lung cancer detection.

Source:

Smeltzer MP, et al. (2025, June 2). JAMA Netw Open. Reducing Smoking Requirements for Lung Screening to Address Health Disparities in a Community Cohort. https://pubmed.ncbi.nlm.nih.gov/40553471/