Current USPSTF lung cancer screening guidelines may prevent early diagnosis in many cases, according to research presented at the American Association for Thoracic Surgery (AATS) Annual Meeting.

In a study of nearly 1200 patients who underwent lung cancer surgery, 43% of those with early-stage lung cancer and 41% of those with stage IV lung cancer would have been ineligible for lung cancer screening under the 2021 United States Preventive Services Task Force (USPSTF) guidelines.

For this study, researchers analyzed patients from the Southern Community Cohort Study, which includes low-income adults from 12 southeastern US states. The analysis included 267 patients with early-stage lung cancer and 909 patients with metastatic lung cancer. 

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In the early-stage cohort, 55% of patients were Black, 41% were White, and 4% were other races. Sixty-two percent of patients were current smokers, 28% former smokers, and 10% never smokers. 

In the metastatic cohort, 63% of patients were Black, 33% were White, and 4% were other races. Seventy-two percent of patients were current smokers, 23% former smokers, and 5% never smokers.

The proportion of patients eligible for lung cancer screening according to the 2021 USPSTF guidelines was 57% in the early-stage cohort and 59% in the metastatic cohort. In comparison, 64% of both cohorts would have been eligible according to National Comprehensive Cancer Network (NCCN) guidelines. 

Having a smoking history of less than 20 pack-years was the main reason that patients in both lung cancer cohorts would have been ineligible for screening under the 2021 USPSTF guidelines. 

Former smokers were significantly less likely to be eligible for screening under the USPSTF guidelines than patients who currently smoked (51% and 69%, respectively; P =.008). On the other hand, there was no significant difference in screening eligibility between current and former smokers with NCCN guidelines (74% and 70%, respectively; P =.48). 

The researchers also compared the early-stage lung cancer patients to surgical patients with early-stage breast cancer or colon cancer from the National Cancer Database. The proportion of patients eligible for screening according to USPSTF guidelines was 85% for colon cancer and 77% for breast cancer, compared to 57% for lung cancer. 


Potter A, Yehia M, McCarthy M, et al. Evaluating the lung cancer screening eligibility of patients undergoing lung cancer operations: An analysis of the Southern Community Cohort Study. AATS 2023. May 6-9, 2023. Abstract 16.