Lung Cancer Screening Among Head and Neck Cancer Survivors

Survivors of head and neck cancer are at elevated risk for secondary primary lung cancer, independent of smoking history, yet LDCT screening in this population is both likely underutilized and inconsistently captured in national survey data, in part because the smoking-history elements needed to determine eligibility are often missing. We used nationally representative 2022 Behavioral Risk Factor Surveillance System data to examine lung cancer screening prevalence among head and neck cancer survivors and screening patterns by eligibility under 2013 and 2021 US Preventive Services Task Force criteria. More than one-third of survivors lacked sufficient information on smoking history to assess eligibility. Screening was highest among survivors meeting 2013 criteria (64%) compared with those eligible under 2021 criteria (40%) and those ineligible under either criterion (32%). The 2021 criteria expansion increased the number of survivors eligible for screening but did not translate into a proportional increase in CT scanning rates. These findings suggest that eligibility expansion alone may be insufficient without systematic collection of smoking history and streamlined referral pathways.