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Related Experiment Video

Updated: May 13, 2026

Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index
06:55

Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index

Published on: January 8, 2020

Estimating Lung Cancer Screening Eligibility in the Veterans Health Administration Using Patient-Reported Smoking

Lawrence N Benjamin1,2, Yash Motwani3, Carol M Mangione3,4

  • 1Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA. LBenjamin@mednet.ucla.edu.

Journal of General Internal Medicine
|May 11, 2026
PubMed
Summary

Over one million Veterans aged 50-80 are eligible for lung cancer screening (LCS) based on current guidelines. Understanding this population

Keywords:
American Cancer SocietyLung cancer screeningUnited States Preventive Services Task ForceVeterans Health Administration

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Last Updated: May 13, 2026

Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index
06:55

Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index

Published on: January 8, 2020

Area of Science:

  • Public Health
  • Oncology
  • Health Services Research

Background:

  • The Veterans Health Administration (VHA) serves a high-risk population for lung cancer, yet lung cancer screening (LCS) rates have been historically low.
  • Accurate estimation of the LCS-eligible population is crucial for improving screening rates, but quantifying smoking history (pack-years) at scale has been a challenge.
  • Recent implementation of structured smoking data within VHA LCS initiatives enables more robust identification of eligible individuals.

Purpose of the Study:

  • To estimate the size and characteristics of the LCS-eligible population within the VHA nationwide.
  • To assess eligibility based on recommendations from the United States Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS).

Main Methods:

  • A retrospective, cross-sectional analysis was conducted using nationwide VHA clinical and administrative data from 2015 to 2021.
  • The study included age-restricted Veterans with at least one outpatient visit during the specified period.
  • Structured smoking data allowed for precise calculation of pack-years to determine screening eligibility.

Main Results:

  • A cohort of 1,422,573 Veterans with structured smoking histories was identified.
  • An estimated 23.1% of Veterans aged 55-80 met 2013 USPSTF criteria; 27.9% aged 50-80 met 2021 USPSTF criteria; and 28.0% met ACS criteria.
  • Significant regional variations in eligibility, high rates of comorbid mental/cognitive illness or substance abuse, and disparities in eligibility across racial/ethnic groups were observed. Estimates are based on EHR data and may have biases.

Conclusions:

  • Over one-quarter of Veterans aged 50-80 meet current LCS eligibility criteria, representing over 1 million individuals.
  • Characterizing this eligible population is essential for developing targeted interventions to enhance lung cancer screening rates.
  • The findings highlight the substantial number of Veterans who could benefit from lung cancer screening.