New Guidelines Expand Eligibility for Lung Cancer Screening

The updated American Cancer Society guidelines widen the age range and change the smoking history criteria required for lung cancer screening eligibility.

About one in five of all cancer deaths in the United States are caused by lung cancer. While early diagnosis and treatment can reduce the chances of dying from the disease, lung cancer symptoms, such as a chronic cough, chest pain, and shortness of breath, often don’t appear until the cancer has reached an advanced stage. Moreover, people experiencing symptoms may think it’s something else, like the negative effects of smoking.

In the past, the American Cancer Society recommended yearly lung cancer screening for people ages 55 to 74 who have a smoking history of 30 pack years and currently smoke or quit smoking less than 15 years ago.

However, those recommendations have now changed.

In a 2023 guideline update published on November 1 in CA: A Cancer Journal for Clinicians, the American Cancer Society now recommends that people aged 50 to 80 years, who smoke or previously smoked, and have at least a 20-pack-year smoking history get yearly lung cancer screenings with a low-dose computed tomography (LDCT) scan.

One pack-year is smoking one pack — or about 20 cigarettes — a day for one year. So, a 20-pack-year smoking history is equal to smoking one pack a day for 20 years, two packs per day for 10 years, or one and a half packs a day for slightly over 13 years.

The ACA also recommends against using the number of years since a former smoker quit as criteria for screening. Instead, all people with at least a 20-pack-year smoking history, regardless of when they quit, should have an LDCT scan.

The ACA recommends this type of scan instead of a chest X-ray as LDCT scans are more effective at identifying abnormalities in the lungs, which can help detect lung cancer earlier.

The new lung cancer screening recommendations also promote shared decision making between patients and healthcare providers. The ACA says that before a person undergoes screening, they should consider the benefits and potential harms of the test. In addition, doctors should offer current smokers information on smoking cessation interventions that can help them quit.

However, the ACA does not recommend lung cancer screening for people who have a serious health condition that will likely limit how long they’ll live or those who won’t be able to access treatment or don’t want treatment if the screening leads to a cancer diagnosis.

Because of these guideline changes, the ACA estimates that nearly five million more individuals will become eligible for lung cancer screening each year.

Guideline co-author Robert Smith, Ph.D., Senior Vice President of Early Cancer Detection Science at the American Cancer Society, said, "It’s critical to both help health care providers identify people who are eligible for screening and to increase awareness among people who currently smoke or formerly smoked to talk with their health care providers about lung cancer screening."