An observational study using 2024 National Health Interview Survey data suggests lung cancer screening criteria based on years smoked may identify more individuals who could benefit from screening compared to current U.S. Preventive Services Task Force (USPSTF) guidelines. The research, conducted by Lauren Kearney and colleagues at Boston University School of Medicine, was published in JAMA Internal Medicine.

The study categorized individuals using the Life-Years from Screening–CT model to project life expectancy increases with screening. Kearney stated, "Smoke duration thresholds are simple to apply and identify more people who may benefit from [lung cancer screening] than USPSTF criteria."

The USPSTF expanded its eligibility criteria for lung cancer screening in 2021, lowering the pack-year threshold to 20 years and the age for screening initiation to 50 years. The study found that USPSTF guidelines captured 77% of individuals deemed to be of the highest benefit. In comparison, a smoking duration threshold of at least 40 years captured 85% of these highest-benefit individuals and excluded 100% of the lowest-benefit individuals. USPSTF guidelines excluded 98% of the lowest-benefit individuals.

Further analysis showed that a smoking duration threshold of at least 30 years captured 97% of the highest-benefit individuals. A threshold of at least 20 years of smoking identified 99% of the highest-benefit individuals. Among those selected by the criterion of at least 40 years of smoking, 68.8% were highest-benefit individuals, with 0.1% being lowest-benefit individuals. A threshold of at least 30 years excluded 69% of the lowest-benefit individuals.

Kearney noted, "Emerging evidence suggests total years smoked may better capture risk than current guidelines." She also explained the trade-offs involved, stating, "However, they entail trade-offs between effectiveness and efficiency and population size." She added that decision-makers must weigh these trade-offs based on priorities such as resource availability and the need to avoid missing individuals who could gain the most from screening. Kearney said the optimal years-smoked threshold for screening remains uncertain.

The mean age of the study population was 59.1 years, with 55% being men. The mean years smoked among this population was 26. Kearney concluded that criteria should be implemented with individualized risk assessment, decision support, and capacity planning to balance benefits, harms, and feasibility.