Characteristics of the Newly Eligible Population under Two Recent Updates of Lung Cancer Screening Recommendations.

Abstract

The United States Preventive Services Task Force updated its lung cancer screening (LCS) recommendations in 2021, and the American Cancer Society (ACS) updated its LCS guidelines in 2023. Each update expanded screening eligibility criteria, thus increasing the total number of individuals eligible for LCS. However, it is not clear whether different population subgroups benefit equally from the recent updates of LCS recommendations in terms of becoming newly eligible. We identified 85,395 individuals who were between 50 and 80 years old, smoked cigarettes formerly or currently, and did not have a history of lung cancer from the Behavioral Risk Factor Surveillance System survey of 2022. We used descriptive analysis to illustrate the weighted proportions of the newly screening-eligible population among different subgroups. We also applied multivariable logistic regression models to estimate the ORs of being newly eligible for LCS under each LCS recommendation update in 2021 and 2023. For both LCS updates, individuals who were non-Hispanic White males and had chronic obstructive pulmonary disease were significantly more likely to become newly eligible for LCS. A significantly larger proportion of older-age individuals became newly eligible under the 2023 ACS guideline. Noticeably, both guideline updates substantially increased the population eligible for screening among males and older individuals, two groups experiencing the majority of lung cancer incidence and mortality. Results also indicate that the screening eligibility criteria updates did not increase the OR of being eligible among racial/ethnic minority and female subgroups. Prevention Relevance: This study examines the evolving LCS guidelines and their public health impact. Analyzing the 2021 United States Preventive Services Task Force and 2023 ACS updates, we show expanded eligibility but persistent disparities among sociodemographic groups. Our findings highlight the need for targeted interventions to improve screening uptake and promote equitable, inclusive prevention strategies.