Age-Based Lung Cancer Screening Could Dramatically Improve Early Detection

A cohort study suggests that expanding lung cancer screening to an age-based model could identify nearly all cases of lung cancer and potentially prevent more than 26,000 deaths each year.

The findings, published in JAMA Network Open, highlight a significant gap in current screening practices, which rely heavily on smoking history and consequently miss the majority of individuals who ultimately develop the disease. By shifting to a broader, age-driven strategy, the United States could dramatically improve early detection and reduce lung cancer mortality at a cost far lower than other cancer screening programs.

Lung Cancer Statistics and Screening in the US

Lung cancer remains the leading cause of cancer death in the US, responsible for more fatalities than breast, prostate, and colorectal cancers combined. Early detection is critical—when caught at a localized stage, 5-year survival rates exceed 60%, yet only about one-quarter of cases are diagnosed this early.

Current US Preventive Services Task Force (USPSTF) guidelines recommend annual low-dose CT screening for adults ages 50 to 80 with a significant smoking history. However, screening uptake remains low nationwide, and the eligibility criteria themselves exclude many individuals who develop lung cancer—including women, never-smokers, and racial and ethnic minorities. As a result, many high-risk individuals are diagnosed only after symptoms appear, often when the disease is already advanced.

Study Design and Screening Assessment

Researchers conducted a retrospective cohort study of 997 patients diagnosed with lung cancer between 2018 and 2023 to evaluate how many would have been eligible for screening under existing guidelines. They also modeled alternative screening strategies, including broader risk-based criteria and a fully age-based approach, to estimate their potential impact on case detection, mortality, and cost-effectiveness.

The team analyzed demographic data, smoking history, cancer stage, histology, and overall survival for each patient. They then applied current USPSTF criteria to determine eligibility and simulated expanded screening scenarios. These models included lowering smoking thresholds, broadening age ranges, and testing an age-based strategy in which all adults aged 40 to 85 would be screened.

Cost-effectiveness was evaluated by estimating deaths prevented, life-years gained, and costs per life saved across different approaches. The models accounted for downstream evaluation, radiation exposure, and survival benefits associated with earlier-stage diagnosis.

Major Outcomes and Screening Implications

Only 35.1% of patients diagnosed with lung cancer met current USPSTF eligibility criteria—meaning nearly two-thirds of cases would not have been eligible for screening at the time of diagnosis. Those excluded were more likely to be women, Asian individuals, never-smokers, and patients diagnosed with adenocarcinoma. Notably, this nonguideline group actually had longer overall survival, suggesting they were more likely to be diagnosed at earlier stages despite lack of screening eligibility.

When researchers modeled expanded smoking-based criteria, capture rates improved but still left a substantial proportion of cancers undetected. The most significant improvement came from age-based screening, which would have identified 93.9% of lung cancer cases in the cohort. This approach could prevent an estimated 26,124 deaths annually at a cost of roughly $101,000 per life saved, far lower than comparable cancer screening programs.

By demonstrating that age-based screening could identify the vast majority of cases, the findings point to a meaningful opportunity to reshape national screening policy. As lung cancer incidence increasingly affects diverse populations, including never-smokers and younger adults, broader screening strategies may be essential to improving early detection, reducing disparities, and ultimately lowering mortality.

REFERENCES

Yang HC, Chang A, Visa M, et al. Age-Based Screening for Lung Cancer Surveillance in the US. JAMA Netw Open. November 20, 2025. doi:10.1001/jamanetworkopen.2025.46222