Key Lung Cancer Publications
Below are key research articles relevant to lung cancer screening
Lung Cancer Screening Saves Lives, but Could Save So Many More
By: Alexandra L. Potter, Lecia V. Sequist, Chi-Fu Jeffrey Yang
Where: JAMA, 2025
This commentary highlights the enormous unrealized potential of lung cancer screening in the United States. Although low-dose CT screening already prevents an estimated 15,000 lung cancer deaths every five years, the vast majority of eligible individuals are not being screened. The authors note that if screening uptake reached all eligible individuals, more than 62,000 deaths could be prevented over five years. The article also argues that current screening eligibility criteria miss many high-risk individuals—particularly those who smoked for long durations but accumulated fewer pack-years or quit more than 15 years ago.
By: Alexandra L. Potter, Q. Guo, D. Srinivasan, M. Yang, M. McCarthy, D. Wang, et al.
Where: Annals of Thoracic Surgery, 2025
This study examined lung cancer screening eligibility among more than 7,000 patients diagnosed with lung cancer in the Boston Lung Cancer Study. The analysis found that fewer than half of patients who ultimately developed lung cancer would have met the 2021 USPSTF screening criteria. The authors also showed that removing the requirement that former smokers must have quit within the past 15 years would substantially increase eligibility, supporting recent updates to lung cancer screening recommendations.
Screening for Lung Cancer: 2023 Guideline Update From the American Cancer Society
By: Wolf AMD, Oeffinger KC, Shih TY, Walter LC, Church TR, Fontham ETH, et al.
Where: CA: A Cancer Journal for Clinicians, 2024
The American Cancer Society issued its first update to lung cancer screening guidelines since 2013, recommending annual low-dose CT scans for adults aged 50–80 who have at least a 20 pack-year smoking history, regardless of whether they currently smoke or when they quit. Unlike earlier guidelines, the update removed the requirement that former smokers must have quit within the past 15 years to qualify. This change significantly expands screening eligibility and may improve access for groups—especially Black individuals—who were more likely to be excluded under earlier criteria.
By: Alexandra L. Potter, S. Kuhan, P. Senthil, A. Mansur, C. Haridas, D. Srinivasan, et al.
Where: Cancer, 2024
This study evaluated how well the 2021 USPSTF lung cancer screening criteria capture individuals who ultimately develop lung cancer. The researchers found that although the guideline expansion increased overall eligibility, younger Black patients remained disproportionately excluded from screening compared with White patients. Much of this disparity was due to lower cumulative pack-year histories at diagnosis, highlighting the limitations of using pack-year thresholds alone to determine screening eligibility.
Persistent Race- and Sex-Based Disparities in Lung Cancer Screening Eligibility
By: Alexandra L. Potter, P. Senthil, D. Srinivasan, V. Raman, A. Kumar, C. Haridas, et al.
Where: Journal of Thoracic and Cardiovascular Surgery, 2024
Using data from the Southern Community Cohort Study, this analysis examined how eligibility for lung cancer screening varies by race and sex under the 2021 USPSTF guidelines. The authors found substantial disparities in screening eligibility among patients diagnosed with lung cancer: only about half of Black women and roughly two-thirds of Black men would have qualified for screening compared with roughly three-quarters of White patients. The primary reason for ineligibility among Black patients was lower pack-year smoking histories.
By: Alexandra L. Potter, N. Xu, P. Senthil, D. Srinivasan, H. Lee, G. Gazelle, et al.
Where: Journal of Clinical Oncology, 2024
This study evaluated whether pack-year smoking history—the primary criterion used in lung cancer screening guidelines—effectively identifies individuals at high risk of lung cancer. Using data from two large cohort studies, the researchers found that the 20 pack-year threshold excluded many patients who later developed lung cancer and contributed to significant racial disparities in screening eligibility. Replacing pack-year thresholds with a simpler measure based on smoking duration (such as a 20-year smoking history) substantially increased eligibility and eliminated much of the racial disparity.
Prevalence of Lung Cancer Screening in the United States, 2022
By: Henderson LM, Su IH, Rivera MP, Pak J, Chen X, Reuland DS, Lund JL
Where: JAMA Network Open, 2024
This nationwide study examined how many eligible adults in the United States actually received lung cancer screening after the 2021 guideline expansion. Despite broader eligibility, the findings showed that screening rates remained very low, with most eligible individuals not receiving a low-dose CT scan in the previous year. The study also found persistent disparities in screening by race, income, education level, and geographic location, suggesting that policy changes alone have not yet produced widespread or equitable screening access.
Evaluating Eligibility of US Black Women Under USPSTF Lung Cancer Screening Guidelines
By: Alexandra L. Potter, Chi-Fu Jeffrey Yang, K. Woolpert, T. Puttaraju, K. Suzuki, J. Palmer
Where: JAMA Oncology, 2022
This study used data from the Black Women’s Health Study—a large prospective cohort of more than 58,000 participants—to evaluate whether the 2021 USPSTF lung cancer screening guidelines effectively identify Black women at risk for lung cancer. The analysis found that roughly 60% of Black women diagnosed with lung cancer would not have qualified for screening under the updated criteria. The findings highlight important equity gaps in screening eligibility and suggest that revised screening strategies may be needed to better capture high-risk populations.
By: Alexandra L. Potter, A. Rosenstein, M. Kiang, S. Shah, H. Gaissert, D. Chang, et al.
Where: The BMJ, 2022
This population-level study examined how the introduction of low-dose CT lung cancer screening affected stage at diagnosis and survival in the United States. The researchers found that after screening programs were implemented, a significantly larger proportion of lung cancers were detected at early stages—when they are most treatable. The study also estimated that screening has already saved roughly 10,000 lives in the United States by shifting diagnoses toward earlier stages of disease.
Screening for Lung Cancer US Preventive Services Task Force Recommendation Statement
By: US Preventive Services Task Force
Where: JAMA, March 2021
The USPSTF updated its lung cancer screening recommendation, expanding eligibility to include adults aged 50–80 with at least a 20 pack-year smoking history who currently smoke or quit within the past 15 years. Compared to the 2013 recommendation, the new guidelines lowered the starting age from 55 to 50 and reduced the required pack-year history from 30 to 20, nearly doubling the number of Americans eligible for annual low-dose CT screening.
New USPSTF Guidelines for Lung Cancer Screening
By: Yolonda L. Colson, Jo-Anne O. Shepard, Inga T. Lennes
Where: JAMA Surgery, March 2021
This editorial accompanying the 2021 USPSTF guideline update highlights how the expanded eligibility criteria could significantly increase the number of people screened and lives saved. The authors discuss practical considerations for implementing the new guidelines—including the need for shared decision-making and smoking cessation support—and note that important gaps remain in access for underserved populations.
Expanded Access to Lung Cancer Screening- Implementing Wisely to Optimize Health
By: Anne C. Melzer, Timothy J. Wilt
Where: JAMA Network Open, March 2021
This commentary cautions that expanding who qualifies for lung cancer screening is not sufficient on its own. The real-world benefits of screening depend heavily on program quality, appropriate shared decision-making, and integrated smoking cessation support. The authors argue that implementation must be thoughtful to ensure that the mortality benefits seen in clinical trials are realized in diverse, real-world populations.
The Effect of Advances in Lung-Cancer Treatment on Population Mortality
By: Nadia Howlader, Gonçalo Forjaz, Meghan J. Mooradian, Rafael Meza, et al.
Where: New England Journal of Medicine, August 2020
Using national cancer data, this study examined why lung cancer death rates have been declining faster than new case rates in recent years. The researchers found that the sharp drop in lung cancer deaths—particularly after 2013—was driven primarily by advances in treatment, especially immunotherapy and targeted therapies, rather than early detection through screening. The findings highlight how newer treatments have meaningfully extended survival even for patients diagnosed at late stages.
Utilization of Lung Cancer Screening in the Medicare Fee-for-Service Population
By: Tina D. Tailor, Betty C. Tong, Junheng Gao, Louise M. Henderson, et al.
Where: CHEST, June 2020
Despite Medicare covering lung cancer screening starting in 2015, this study found that actual uptake among eligible Medicare patients remained strikingly low—fewer than 2% completed a screening CT scan in the first few years of coverage. Utilization was especially low among racial and ethnic minority groups, rural residents, and those with fewer healthcare contacts, revealing deep disparities in who was actually receiving this potentially life-saving test.
Results of Lung Cancer Screening in the Community
By: John R. Handy, Michael Skokan, Erika Rauch, Steven Zinck, et al.
Where: Annals of Family Medicine, May 2020
This study reported on real-world outcomes from a community-based lung cancer screening program, finding that CT screening outside of large academic medical centers is effective and feasible. A meaningful proportion of screen-detected cancers were found at early, surgically removable stages, and the false-positive rate was manageable. These findings helped establish that high-quality lung cancer screening can be successfully delivered in community settings.
Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial
By: Harry J. de Koning, Carlijn M. van der Aalst, Pim A. de Jong, Ernst T. Scholten, et al.
Where: New England Journal of Medicine, February 2020
The NELSON trial—Europe's largest and most rigorous lung cancer screening trial—found that CT screening reduced lung cancer deaths by 24% in men and by an even larger margin in women at 10 years of follow-up. This landmark study confirmed the U.S. NLST results in an independent population, and used a more precise screening approach that measured nodule volume growth rather than size alone, resulting in fewer false positives and unnecessary follow-up procedures. It has become one of the two cornerstone randomized trials supporting international lung cancer screening guidelines.
By: Yung-Hung Luo, Lei Luo, Jason A Wampfler, Yi Wang, et al.
Where: Lancet Oncology, August 2019
This prospective study compared survival between patients with lung cancer who would have met USPSTF screening criteria and those who would not. A substantial proportion of patients who developed and died from lung cancer would not have qualified for screening under the guidelines—highlighting a critical coverage gap. Ineligible patients had comparable or worse survival outcomes, making the case that current eligibility criteria may be excluding many people who would benefit from earlier detection.
By: Ugo Pastorino, Massimo Silva, Silvia Sestini, Francesca Sabia, et al.
Where: Annals of Oncology, July 2019
The MILD (Multicentric Italian Lung Detection) trial showed that annual CT lung cancer screening over an extended period was associated with a 39% reduction in lung cancer deaths at 10 years compared with no screening. Annual screening outperformed biennial screening. This was one of the first randomized trials outside of the NLST and NELSON to demonstrate a clear mortality benefit, providing important international confirmation that CT screening saves lives.
Evaluation of USPSTF Lung Cancer Screening Guidelines Among African American Adult Smokers
By: Melinda C. Aldrich, Sarah F. Mercaldo, Kim L. Sandler, William J. Blot, et al.
Where: JAMA Oncology, June 2019
This study found that the USPSTF's 2013 screening guidelines—which required 30 pack-years of smoking history—excluded a disproportionately high share of Black Americans who developed lung cancer. Because Black individuals often smoke fewer cigarettes per day but for longer durations, many do not accumulate the required pack-years despite being at elevated risk. The study was influential in demonstrating that standard criteria may perpetuate racial disparities in lung cancer outcomes.
POINT: Should Lung Cancer Screening Be Expanded to Persons Who Don’t Currently Meet Accepted Criteria Set Forth by the CHEST Guidelines on Lung Cancer Screening? Yes
By: Douglas E. Wood
Where: CHEST, June 2018
This opinion piece argues that current lung cancer screening eligibility criteria are too narrow and exclude many high-risk individuals—including those with lower pack-year histories, occupational exposures to carcinogens, or family histories of lung cancer. The author makes the case that risk-prediction models, rather than simple pack-year thresholds, should guide who gets screened, allowing for a more personalized and equitable approach to identifying people at elevated risk.
Selecting Lung Cancer Screenees Using Risk Prediction Models - where do we go from here
By: Martin C Tammemägi
Where: Translational Lung Cancer Research, June 2018
This review discusses the evolution of risk-prediction models for identifying people most likely to benefit from lung cancer screening. The author argues that simple eligibility criteria based on age and pack-years miss many high-risk individuals while including some at lower risk. Models that incorporate additional factors—such as family history, COPD, body mass index, and prior cancer—can more precisely target screening toward those who would benefit most, improving both the efficiency and the equity of screening programs.
Evaluating efficacy of current lung cancer screening guidelines
By: Barbara Nemesure, April Plank, Lisa Reagan, Denise Albano, et al.
Where: Journal of Medical Screening, December 2017
This study tested how well existing lung cancer screening eligibility criteria performed in identifying actual lung cancer cases in a real-world population. The findings showed that a meaningful proportion of patients who developed lung cancer would not have qualified for screening under USPSTF guidelines—suggesting that the criteria need refinement to reduce the number of cases diagnosed too late for effective treatment.
Performance of Lung-RADS in the National Lung Screening Trial: a retrospective assessment
By: Paul F. Pinsky, David S. Gierada, William Black, Reginald Munden, et al.
Where: Annals of Internal Medicine, April 2015
This analysis applied the Lung-RADS classification system—a standardized radiology reporting tool developed after the NLST to better categorize lung nodules—to data from the NLST. When Lung-RADS criteria were applied, the false positive rate dropped substantially compared to the original NLST protocol, with only a modest reduction in cancer detection sensitivity. The findings supported the adoption of Lung-RADS as a practical tool for reducing unnecessary follow-up procedures in screening programs.
Experience with a CT screening program for individuals at high risk for developing lung cancer
By: Brady J. McKee, Jeffrey A. Hashim, Robert J. French, Andrea B. McKee, et al.
Where: Journal of the American College of Radiology, February 2015
This paper reported on early implementation of a community-based CT lung cancer screening program, describing real-world rates of cancer detection, nodule management, and follow-up. The program demonstrated that high-quality lung cancer screening is feasible outside of major academic medical centers, with early-stage cancers detected at meaningful rates. These findings helped establish a practical roadmap for scaling screening programs into community settings.
By: Raja Flores, Thomas Bauer, Ralph Aye, Shahriyour Andaz, et al.
Where: Journal of Thoracic and Cardiovascular Surgery, May 2014
This study examined the balance between finding curable early-stage lung cancers through CT screening and the risk of performing unnecessary surgery on benign nodules. The authors found that while screening does lead to some operations on ultimately non-cancerous lesions, the majority of surgeries performed in a screening context involved true cancers—and most were at early, curable stages. The results support CT screening while acknowledging the ongoing need to minimize overtreatment.
Clinical characteristics and survival in never smokers with lung cancer
By: Isaura Parente Lamelas, José Abal Arca, Nagore Blanco Cid, María Teresa Alves Pérez, et al.
Where: Archivos de Bronconeumología, February 2014
This study described the clinical features and survival of patients diagnosed with lung cancer who had never smoked. Never-smokers with lung cancer tended to present at more advanced stages and had distinct tumor types compared to smokers, but some showed comparable or better survival with appropriate treatment. The findings underscore that lung cancer is not exclusively a disease of smokers and that screening criteria focused solely on smoking history will miss a significant number of people at risk.
Annual number of lung cancer deaths potentially avertable by screening in the United States
By: Jiemin Ma, Elizabeth M Ward, Robert Smith, Ahmedin Jemal
Where: Cancer, April 2013
Using national cancer data and modeling, this study estimated that annual lung cancer CT screening for eligible Americans could prevent tens of thousands of lung cancer deaths each year. The analysis provided a compelling public health rationale for expanding access to CT screening programs and helped quantify the enormous potential impact of wider implementation.
By: Darren R. Brenner, Paolo Boffetta, Eric J. Duell, Heike Bickeböller, et al.
Where: American Journal of Epidemiology, October 2012
This large pooled analysis found that people with a prior history of lung conditions—such as COPD, emphysema, or pneumonia—face a significantly elevated risk of developing lung cancer, independent of their smoking history. These findings suggest that prior lung disease should be considered as an additional risk factor when determining who should qualify for lung cancer screening, potentially broadening eligibility to capture more people at genuinely elevated risk.
By: Paul F Pinsky, Christine D Berg
Where: Journal of Medical Screening, September 2012
This study calculated what fraction of the U.S. population and of actual lung cancer cases would have been eligible for screening under the NLST criteria. While the NLST criteria targeted a relatively small slice of the general population, they captured a larger share of lung cancer cases—though still left a substantial number undetected. The findings supported the argument that eligibility criteria should be broadened to capture more of the lung cancer burden.
By: Douglas E. Wood, George A. Eapen, David S. Ettinger, Lifang Hou, et al.
Where: Journal of the National Comprehensive Cancer Network, February 2012
This early comprehensive guideline from the National Comprehensive Cancer Network (NCCN) laid out clinical recommendations for lung cancer screening, incorporating new evidence from the NLST. Notably, the NCCN guidelines took a broader view of risk than the NLST criteria alone, recommending screening consideration for individuals with additional risk factors such as family history, occupational exposure, or COPD—making it one of the earliest major guidelines to endorse a risk-based approach.
Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening
By: The National Lung Screening Trial Research Team
Where: New England Journal of Medicine, August 2011
The National Lung Screening Trial (NLST) was the first large-scale randomized trial to prove that annual low-dose CT screening reduces lung cancer deaths by 20% among heavy smokers, compared to chest X-ray screening. Enrolling over 53,000 high-risk adults, this landmark study provided the primary scientific foundation for all major lung cancer screening guidelines that followed. It remains the most influential study in the history of lung cancer screening.