Lung Cancer Screening

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In 2015, 4.5% of adults aged 55-80 years who were at risk for lung cancer due to smoking had a CT scan to check for lung cancer within the past year.

Summary graph for Lung Cancer Screening, Click to see detailed view of graph

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Background

Lung cancer screening uses a type of chest computed tomography (CT), known as low radiation dose CT (LDCT), using reduced doses of radiation (as compared to usual chest CT) to create very detailed three-dimensional pictures of the lungs. Doctors use lung cancer screening for early detection of disease in former and current smokers who do not have symptoms. Another name for LDCT is low-dose helical CT.

The U.S. Preventive Services Task Force’s (USPSTF) first lung cancer screening recommendations, issued in 2013, recommended annual LDCT screening for lung cancer in adults aged 55 to 80 years who had a 30 pack-year smoking history or more and who currently smoked or had quit within the past 15 years. The recommendation was based on findings of the National Lung Screening Trial (NLST), a large randomized controlled trial. NLST demonstrated that lung cancer screening with LDCT reduced the risk of dying from lung cancer by 20 percent in people of that age and with that smoking history. In March 2021, the USPSTF published revised guidelines and now recommends annual LDCT screening for lung cancer in adults aged 50 to 80 years who have a 20 pack-year smoking history or more and who currently smoke or have quit within the past 15 years. The revision was based on the NLST results as well as results of other, more recently published, studies, as well as statistical modeling.

Quitting smoking is the best way to reduce the risk of dying from lung cancer. Lung cancer screening is not a substitute for smoking cessation.

Measure

Percentage of adults at risk for lung cancer due to smoking, aged 55-80 years, who had a CT scan to check for lung cancer within the past year, by sex, race/ethnicity, income, education level, age, and smoking pack years.

Measurement challenges

We track lung cancer screening rates in U.S. adults using a large, national, in-person survey in which people are asked about their health behaviors and the medical care they receive (see Data Source, below). There are important limitations to this method that impact what information we can accurately collect and how confident we can be in the findings. Studies have found that certain types of healthcare survey questions can be difficult for people to clearly understand and answer, and it is easy for some questions to be misinterpreted.

National guidelines state that only individuals with extensive cigarette smoking experience be screened for lung cancer, and this report strives to only include eligible individuals in our measures. One challenge we face is calculation of an accurate measure of lifetime smoking, which is needed to determine whether someone is eligible for screening. Cigarette smoking behaviors can vary from day to day and year to year, yet our survey does not capture such time-specific information; instead, we collect information about average lifetime smoking. In addition, it can be difficult for an individual to accurately recall how many cigarettes he or she smoked a day in years past. Furthermore, an individual may underreport amount smoked given the stigma associated with the activity.

In the case of lung cancer screening, it can be challenging to determine by self-report alone if an individual received an LDCT for the purposes of looking for asymptomatic, previously undetected cancer or precancers (i.e., for screening purposes), or to follow up on symptoms or suspicious findings from a prior test (i.e., for diagnostic purposes). Patients may not know the difference between a screening LDCT and a diagnostic LDCT. Therefore, we ask individuals whether they received an exam to check for lung cancer, and our measures include both screening and diagnostic LDCTs. Though people may have reported LDCT exams that occurred for surveillance following lung cancer diagnosis and treatment, as of 2021 we exclude individuals previously diagnosed with lung cancer, thus minimizing inclusion of surveillance exams. We also exclude individuals who report having an exam to check for lung cancer but then report that they had no exams in the last three years.

The challenges noted above can lead to the overreporting and underreporting of smoking and lung cancer screening; therefore, it is difficult to know whether our measures of lung cancer screening in eligible individuals are overestimates or underestimates. We do not believe that errors are extensive, and as such, we feel that our measures provide good estimates of the true magnitude of lung cancer screening. Furthermore, these data are widely considered to be the best national data on lung cancer screening and are used frequently to track lung cancer screening rates in the U.S.

In addition to the challenges noted above, lung cancer screening is somewhat unique among cancer screening modalities because it does not apply to everyone in a specified age range, but rather only current or former heavy smokers in the age range. This means that the denominator of eligible individuals is considerably smaller than that for other screening modalities. Thus the resultant estimates from NHIS of those screened among the eligible population will have considerably larger standard errors (especially relative to the size of the estimates) than for other cancer sites, and should be interpreted with caution.

Healthy People 2030 Target

Increase to 7.5 percent the proportion of adults aged 55 to 80 years who receive lung cancer screening based on the 2013 USPTF recommendations. Recommendations are restricted to individuals who have never had lung cancer, have smoked at least 30 pack-years, and if former smokers, have quit no more than 15 years ago.

Healthy People 2030 is a set of goals set forth by the Department of Health and Human Services.

Note: Goals are indicated as blue line on Detailed Trend Graphs.

Data Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2010–2015.

Please note that these data were collected while the 2013 USPSTF recommendations were in place. Therefore, the estimates include adults aged 55 to 80 who had a 30 pack-year smoking history or more and who currently smoked or had quit within the past 15 years.

Trends and Most Recent EstimatesHelp with navigating the graphs and data tables

By Sex

Percentage of adults at risk for lung cancer due to smoking¹, aged 55-80 years, who had a CT scan to check for lung cancer within the past year by sex, 2010-2015
Overview Graph Detailed Trend Graphs Most Recent Estimates (2015)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults at risk for lung cancer due to smoking¹, aged 55-80 years, who had a CT scan to check for lung cancer within the past year by sex, 2010-2015 Both SexesClick to see the detailed trend graph for Both Sexes 4.5 2.8 - 7.2
MaleClick to see the detailed trend graph for Male 4.5 2.7 - 7.4
FemaleClick to see the detailed trend graph for Female 4.5 1.8 - 10.5

By Race/Ethnicity

Percentage of adults at risk for lung cancer due to smoking¹, aged 55-80 years, who had a CT scan to check for lung cancer within the past year by race/ethnicity, 2010-2015
Overview Graph Detailed Trend Graphs Most Recent Estimates (2015)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults at risk for lung cancer due to smoking¹, aged 55-80 years, who had a CT scan to check for lung cancer within the past year by race/ethnicity, 2010-2015 All RacesClick to see the detailed trend graph for All Races 4.5 2.8 - 7.2
Non-Hispanic WhiteClick to see the detailed trend graph for Non-Hispanic White 4.9 3.0 - 8.0
Non-Hispanic BlackClick to see the detailed trend graph for Non-Hispanic Black 1.7 0.6 - 5.0
HispanicClick to see the detailed trend graph for Hispanic 0.7 0.1 - 4.6

By Poverty Income Level

Percentage of adults at risk for lung cancer due to smoking¹, aged 55-80 years, who had a CT scan to check for lung cancer within the past year by poverty income level, 2010-2015
Overview Graph Detailed Trend Graphs Most Recent Estimates (2015)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults at risk for lung cancer due to smoking¹, aged 55-80 years, who had a CT scan to check for lung cancer within the past year by poverty income level, 2010-2015 <200% of federal poverty levelClick to see the detailed trend graph for <200% of federal poverty level 3.6 2.0 - 6.5
>=200% of federal poverty levelClick to see the detailed trend graph for >=200% of federal poverty level 5.0 2.7 - 9.1

By Education Level

Percentage of adults at risk for lung cancer due to smoking¹, aged 55-80 years, who had a CT scan to check for lung cancer within the past year by highest level of education obtained, 2010-2015
Overview Graph Detailed Trend Graphs Most Recent Estimates (2015)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults at risk for lung cancer due to smoking¹, aged 55-80 years, who had a CT scan to check for lung cancer within the past year by highest level of education obtained, 2010-2015 Less than High SchoolClick to see the detailed trend graph for Less than High School 2.3 1.1 - 4.7
High SchoolClick to see the detailed trend graph for High School 7.0 4.0 - 11.8
Greater than High SchoolClick to see the detailed trend graph for Greater than High School 3.8 1.4 - 9.6

By Age

Percentage of adults at risk for lung cancer due to smoking¹, aged 55-80 years, who had a CT scan to check for lung cancer within the past year by age, 2010-2015
Overview Graph Detailed Trend Graphs Most Recent Estimates (2015)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults at risk for lung cancer due to smoking¹, aged 55-80 years, who had a CT scan to check for lung cancer within the past year by age, 2010-2015 Ages 55-64Click to see the detailed trend graph for Ages 55-64 2.2 1.2 - 3.8
Ages 65-80Click to see the detailed trend graph for Ages 65-80 6.6 3.7 - 11.7

By Smoking Pack Years

Percentage of adults at risk for lung cancer due to smoking¹, aged 55-80 years, who had a CT scan to check for lung cancer within the past year by smoking pack years, 2010-2015
Overview Graph Detailed Trend Graphs Most Recent Estimates (2015)
Percent of adults 95% Confidence Interval
Thumbnail of graph for Percentage of adults at risk for lung cancer due to smoking¹, aged 55-80 years, who had a CT scan to check for lung cancer within the past year by smoking pack years, 2010-2015 30-39 YearsClick to see the detailed trend graph for 30-39 Years 6.2 2.5 - 14.6
40+ YearsClick to see the detailed trend graph for 40+ Years 4.1 2.3 - 7.2

Additional Information on Lung Cancer Screening

As noted in the Background section, the USPSTF published revised lung cancer screening guidelines in March, 2021. Some of the sources included in this section reflect the revision, but most have not yet been updated. Nevertheless, they provide other useful information. Lung cancer screening resources that reflect the 2021 guidelines are marked *2021 GUIDELINES*.

Year Range

2010-2015

Recent Summary Trend Year Range

2010-2015

Summary Tables

Breast and Cervical Cancers

Recent Summary Trend

Non-Significant Change

Desired Direction

Rising