The 2021 US Preventive Services Task Force Lung Cancer Screening Criteria Miss Many Patients Diagnosed With Early and Late-Stage Lung Cancer: Analysis of 3 Cohort Studies

Alexandra L Potter; Quiana Guo; Bryan Rettner; Alexander Zhu; Ava Potter; Wei Zheng; Jui Kothari; Andrea Shafer; Linda W Martin; Mary M Pasquinelli; David C Christiani; Chi-Fu Jeffrey Yang

doi:10.1016/j.chest.2026.01.033

The 2021 US Preventive Services Task Force Lung Cancer Screening Criteria Miss Many Patients Diagnosed With Early and Late-Stage Lung Cancer: Analysis of 3 Cohort Studies

Chest. 2026 Mar 24:S0012-3692(26)00380-6. doi: 10.1016/j.chest.2026.01.033. Online ahead of print.

Authors

Affiliations

¹ Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA.
² Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Nashville, TN; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN.
³ Pulmonary Care and Critical Unit, Massachusetts General Hospital, Boston, MA.
⁴ Department of Surgery, University of Virginia, Charlottesville, VA.
⁵ Department of Medicine, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago, Chicago, IL.
⁶ Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: cjyang@mgh.harvard.edu.

PMID: 41887280
DOI: 10.1016/j.chest.2026.01.033

Abstract

Background: Lung cancer screening (LCS) aims to detect lung cancers-that have historically been diagnosed at late stages-at earlier stages when the likelihood of cure is high. However, the proportion of individuals diagnosed with late-stage lung cancer in the US who would have qualified for LCS is unknown.

Research question: What proportion of individuals diagnosed with early stage vs late-stage lung cancer would have qualified for LCS under the 2021 US Preventive Services Task Force (USPSTF) recommendation?

Study design and methods: Participants diagnosed with lung cancer in the Boston Lung Cancer Study (BLCS), a cancer epidemiology cohort study in Boston, Massachusetts, and the Southern Community Cohort Study (SCCS) and Multiethnic Cohort Study (MECS), 2 large-scale US prospective cohort studies, were identified. In each cohort, we grouped participants according to whether they were diagnosed with early stage or late-stage lung cancer. The proportion of participants with late-stage lung cancer eligible under the 2021 USPSTF recommendation was evaluated and compared with that among participants with early stage lung cancer.

Results: A total of 7,017 participants in the BLCS, 1,807 in the SCCS, and 5,681 in the MECS were included. Among participants with late-stage lung cancer, the proportion eligible under the 2021 USPSTF recommendation was 41.2% in the BLCS, 58.9% in the SCCS, and 41.4% in the MECS. Similar proportions of participants diagnosed with early stage vs late-stage lung cancer met the USPSTF criteria in each cohort. The most common reason for ineligibility among both groups of participants was smoking < 20 pack-years in the SCCS and MECS and stopping smoking > 15 years ago in the BLCS.

Interpretation: Our results show that, in this analysis of nearly 15,000 participants with lung cancer, only 41% to 59% of participants with late-stage lung cancer would have met the 2021 USPSTF recommendation; similar proportions of participants with early stage lung cancer would have met the 2021 USPSTF recommendation.

Keywords: early detection; health policy; lung cancer; lung cancer screening.