Assessing Lung Cancer Screening Eligibility of Lung Cancer Patients in the Boston Lung Cancer Study: An Analysis of 7,186 Lung Cancer Cases.

Abstract

Background: To evaluate the proportion of lung cancer patients who would have qualified for lung cancer screening under different eligibility criteria in the Boston Lung Cancer Study (BLCS).

Methods: BLCS participants diagnosed with lung cancer from 1992-2024 were identified for analysis. The proportion of patients who would have qualified for screening under the 2021 U.S. Preventive Services Task Force (USPSTF) (age 50-80, >20-pack-years, <15 quit-years), 20-year duration (age 50-80, 20-year smoking duration, <15 quit-years), American Cancer Society (age 50-80, >20-pack-years), NCCN-category-A (age >50, >20-pack-years), and NCCN-category-AB (aged >50, >20 pack-years OR >20-year smoking duration) guidelines were evaluated. We also evaluated the proportion of patients with a smoking history ineligible for screening under the aforementioned guidelines who had a PLCOm2012 risk score > 1.0%.

Results: Of 7,186 patients meeting inclusion criteria, 33.4% currently smoked, 52.1% formerly smoked, and 14.5% had never smoked. Among these patients, 46.1% met the USPSTF guideline, 48.9% met the 20-year duration guideline, 61.0% met the American Cancer Society guideline, 66.1% met the NCCN-category-A guideline, and 71.7% met the NCCN-category-AB guideline. While the PLCOm2012 1.0% risk threshold identified 52.2% of patients with a smoking history who were ineligible for screening under the USPSTF criteria, the PLCOm2012 1.0% risk threshold excluded the majority of patients with <20 pack-years.

Conclusions: In this analysis of 7,186 lung cancer patients, only 46.1% would have met the USPSTF criteria. Including a smoking duration criterion and removing the 15-years-since-quitting criterion from the USPSTF guideline would increase the proportion of patients eligible for screening.