The American Cancer Society has significantly expanded its recommendations for who should receive annual lung cancer screening, a move that could lead to millions more current and former smokers getting checked for the deadly disease.
In new guidance published Wednesday, the nation’s largest cancer charity now says screening should be available to a much broader population – not just those who smoked heavily and recently quit. The changes come as lung cancer remains the leading cause of cancer deaths in the U.S.
Key Points:
- The American Cancer Society now recommends annual lung cancer screening for people ages 50-80 who have at least a 20 pack-year smoking history.
- Previously, screening was recommended only for those who smoked heavily and quit within the last 15 years. The new guidance eliminates any consideration of when someone quit smoking.
- The change means nearly 5 million additional Americans are now eligible for annual low-dose CT scans to detect lung cancer early when it’s most treatable.
- Lung cancer screening is credited with reducing the disease’s mortality rate, but currently only about 10-15% of eligible smokers get checked.
- The updated recommendations align with new modeling evidence showing elevated lung cancer risk persists in older former smokers.
Expanded Eligibility
Under the new recommendations, current or former smokers ages 50-80 should get annual lung cancer screening if they have at least a 20 pack-year history.
A pack-year means smoking an average of one pack per day for a year. So someone who smoked two packs a day for 10 years or one pack per day for 20 years would meet the 20 pack-year threshold.
Previously, the American Cancer Society recommended screening from ages 55-74 for those with a 30 pack-year history who either currently smoke or quit within the past 15 years.
“We now see that the risk continues for men and women in their 60s and above, and so that is exactly the time when you should be screening because that’s when their cancer risk is actually the highest,” said Dr. William Dahut, chief scientific officer for the American Cancer Society.
By eliminating the 15-year since quitting requirement and expanding the age range, the American Cancer Society estimates 5 million more Americans will now meet the criteria for annual screening with low-dose CT scans.
Lung Cancer Mortality Could Decline Further
Since being recommended in 2013, lung cancer screening has been credited with reducing mortality from the disease by 20% among those eligible by detecting tumors early when they are more treatable.
But screening rates remain low, with only about 10-15% of the population who should be checked getting scanned.
With the expanded criteria, the American Cancer Society projects a further 21% decline in lung cancer deaths by catching more cases in early stages.
Lung cancer remains the leading cause of cancer mortality in the U.S., with an estimated 236,000 new cases and 130,000 deaths in 2023. Cigarette smoking is linked to 80-90% of lung cancer cases.
“We think the best opportunity to reduce deaths from lung cancer is to find it early when it’s small before it spreads,” said Dr. Robert Smith of the American Cancer Society. “And screening has been demonstrated to save lives.”
Guidelines May Continue to Evolve
The updated recommendations bring the American Cancer Society more in line with separate guidance on lung cancer screening issued by the U.S. Preventive Services Task Force.
In 2021, the task force recommended annual screening from ages 50-80 for those with a 20 pack-year smoking history who either currently smoke or quit within the past 15 years.
Some experts predict screening criteria could continue expanding as more evidence accumulates, including perhaps lowering the age range and required smoking history.
“The new guidelines from the American Cancer Society, I think, are reflective of newer modeling evidence,” said Dr. Matthew Triplette, a lung cancer screening expert not involved with the new recommendations. “In that, they are saying risk does not stop when you quit smoking for 15 years.”
For now, the American Cancer Society advises anyone who meets the updated criteria to speak with their doctor about getting annual low-dose CT scans, which are typically covered by Medicare and private insurers for those eligible.
Early detection remains the best way to improve lung cancer survival rates, experts say. The new recommendations open screening to millions more current and former smokers who may benefit.
