Lung cancer, computer artwork.
Credit: Science Photo Library-SCIEPRO / Getty Images

The American Cancer Society (ACS) released an update of its lung cancer guideline this week expanding the number of people recommended for screening to several million. The new guideline recommends yearly screening for people aged 50 to 80 years old who smoke or formerly smoked and have a 20-year or greater smoking history. Before, people who had stopped smoking for 15 years or longer were not deemed at sufficiently higher risk to justify the cost of screening.

But new data show that while former smokers’ lung cancer risk goes down after they quit, rates of the disease still go up as these people age. When compared with never-smokers, their risks remain three times greater even when 20 or 30 years have passed since they quit, the ACS researchers said.

The new guideline also reduces the number of “pack-years” (years smoking a pack a day) that suggest someone should be screened, from 30 to 20. It also expands the recommended age range for lung cancer screening to 50 to 80 years, from the prior range of 55 to 74 years.

“Recent studies have shown extending the screening age for persons who smoke and formerly smoked, eliminating the ‘years since quitting’ requirement and lowering the pack per year recommendation could make a real difference in saving lives,” said Robert Smith, PhD, senior vice president of the ACS’s early cancer detection science and lead author of the lung cancer screening guideline report. 

The new guideline, last updated in 2013, appears in the ACS flagship journal, CA: A Cancer Journal for Clinicians. The recommended annual screening test for lung cancer is a low-dose computed tomography scan. It has been established that early detection leads to longer survival.

To develop the new guideline, ACS researchers used reviews of the medical literature, computer models, and intervention and surveillance data from the U.S. National Cancer Institute.

“This updated guideline continues a trend of expanding eligibility for lung cancer screening in a way that will result in many more deaths prevented by expanding the eligibility criteria for screening to detect lung cancer early,” said Smith.

Lung cancer is the overall leading cause of cancer death in the United States and is the second most frequently diagnosed malignancy in both men and women. In 2023, ACS researchers estimate 238,340 new cases of lung cancer (117,550 in men and 120,790 in women) will be diagnosed with about 127,070 deaths from the disease (67,160 in men and 59,910 in women). Anyone at any age can get lung cancer. However, the disease mainly occurs in people aged 65 or older.

“This updated guideline is critical to identify all individuals who can benefit from the early detection of lung cancer,” said Lisa Lacasse, president of ACS’s advocacy affiliate, the American Cancer Society Cancer Action Network (ACS CAN), which advocates for policies to expand access to lung cancer screenings and tobacco control.

“The good news is our research shows the number of new lung cancer cases diagnosed each year continues to decrease, partly because more people are quitting smoking (or not starting),” added Smith. “The number of deaths from lung cancer continues to drop as well, due to fewer people smoking and advances in early detection and treatment, but we still have to do better. This updated guideline is a step in the right direction.

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