Eligibility for Lung Cancer Screening Under the 2021 US Preventive Services Task Force Recommendation Between...

Lung cancer screening (LCS) aims to detect lung cancers-that have historically been diagnosed at late stages-at earlier stages when the likelihood of cure is high. However, the proportion of individuals diagnosed with late-stage lung cancer in the US who would have qualified for LCS is unknown.

What proportion of individuals diagnosed with early-stage vs late-stage lung cancer would have qualified for LCS under the 2021 US Preventive Services Task Force (USPSTF) recommendation?

Participants diagnosed with lung cancer in the Boston Lung Cancer Study (BLCS), a cancer epidemiology cohort study in Boston, Massachusetts, and the Southern Community Cohort Study (SCCS) and Multiethnic Cohort Study (MECS), 2 large-scale US prospective cohort studies, were identified. In each cohort, we grouped participants according to whether they were diagnosed with early-stage or late-stage lung cancer. The proportion of participants with late-stage lung cancer eligible under the 2021 USPSTF recommendation was evaluated and compared with that among participants with early-stage lung cancer.

A total of 7,017 participants in the BLCS, 1,807 in the SCCS, and 5,681 in the MECS were included. Among participants with late-stage lung cancer, the proportion eligible under the 2021 USPSTF recommendation was 41.2% in the BLCS, 58.9% in the SCCS, and 41.4% in the MECS. Similar proportions of participants diagnosed with early-stage vs late-stage lung cancer met the USPSTF criteria in each cohort. The most common reason for ineligibility among both groups of participants was smoking < 20 pack-years in the SCCS and MECS and stopping smoking > 15 years ago in the BLCS.

Our results show that, in this analysis of nearly 15,000 participants with lung cancer, only 41% to 59% of participants with late-stage lung cancer would have met the 2021 USPSTF recommendation; similar proportions of participants with early-stage lung cancer would have met the 2021 USPSTF recommendation.