Yufei Jia, Junqiang Zhao, M Patricia Rivera
Adults newly captured by the 2023 ACS criteria showed measurable past-12-month LCS uptake, but uptake remained less than half that of USPSTF-eligible adults. These findings suggest early implementation of broader ACS eligibility, while highlighting the need for equity-focused, clinician- or system-triggered strategies to identify former smokers with remote quit history.
BACKGROUND: The 2023 American Cancer Society (ACS) lung cancer screening (LCS) guideline expanded eligibility beyond the 2021 US Preventive Services Task Force (USPSTF) recommendations by removing the 15-year smoking cessation criterion. Screening uptake among adults newly eligible under ACS criteria remains unclear.
RESEARCH QUESTION: How does LCS uptake among adults newly eligible under the 2023 ACS criteria differ from uptake among adults eligible under the 2021 USPSTF criteria?
STUDY DESIGN AND METHODS: We analyzed 2024 National Health Interview Survey data for adults aged 50 to 80 years with a computable pack-year history, current or former smoking history, and no prior lung cancer diagnosis. Respondents were classified as USPSTF-eligible (≥20 pack-years, quit <15 years ago or currently smoke), ACS-only-eligible (≥20 pack-years, quit >15 years ago), or neither-eligible. Outcomes were past-12-month and any reported LCS. Survey-weighted multivariable logistic regression estimated associations between eligibility group and screening uptake.
RESULTS: The analytic sample included 5,987 adults, representing approximately 37.5 million US adults with a smoking history. Overall, 35.2% were USPSTF-eligible, 13.5% ACS-only-eligible, and 51.2% neither-eligible. Past-12-month LCS prevalence was 17.8%, 8.0%, and 3.9%, respectively. Compared with neither-eligible adults, USPSTF eligibility was associated with higher odds of both past-12-month LCS (OR, 4.54; 95% CI, 3.44-5.98) and any reported LCS (OR, 3.44; 95% CI, 2.77-4.27). ACS-only eligibility was associated with higher odds of past-12-month LCS (OR, 1.62; 95% CI, 1.12-2.35) but not any reported LCS. Within the ACS-only group, non-Hispanic Black race and telehealth use were associated with higher screening uptake.
INTERPRETATION: Adults newly captured by the 2023 ACS criteria showed measurable past-12-month LCS uptake, but uptake remained less than half that of USPSTF-eligible adults. These findings suggest early implementation of broader ACS eligibility, while highlighting the need for equity-focused, clinician- or system-triggered strategies to identify former smokers with remote quit history.