Lung Cancer Screening Eligibility and Completion Rates in Adults with Diagnosed Lung Cancer: A Nationally Representative Observational Study

Purpose: The U.S. Preventive Services Task Force (USPSTF) recommends annual lung cancer screening (LCS) with low dose computed tomography (LDCT) for high-risk adults; however, screening rates remain below 25%. This study examines LCS eligibility and LDCT completion among patients diagnosed with lung cancer.

Methods/Materials: Using the 2024 National Health Interview Survey (NHIS), adults aged ≥50 years diagnosed with lung cancer within the past 10 years were included. LDCT eligibility at diagnosis was determined using the 2021 USPSTF criteria based on self-reported smoking history. Multivariable logistic regression with survey weights assessed sociodemographic factors associated with LDCT eligibility and completion.

Results: A weighted sample of 638,702 U.S. adults with lung cancer was included (mean age, 72.6 ± 8.2 years; 51.3% male; 80.7% White, 15.8% Black, 1.8% Asian, and 1.7% other; 1.8% Hispanic or Latino). LCS eligibility could not be determined for 4.6% of patients; among those with determinable eligibility, 52.0% were eligible at the time of diagnosis. In multivariable analysis, women (OR, 0.25; 95% CI, 0.09–0.74), Hispanic patients (OR, 0.06; 95% CI, 0.00–0.81), and increasing age (OR, 0.87; 95% CI, 0.80–0.95) were less likely to be LCS eligible. Compared with privately insured patients, those with public insurance (OR, 3.39; 95% CI, 1.11–10.36) and uninsured patients (OR, 17.74; 95% CI, 2.41–130.48) were more likely to be LCS eligible. Overall, 31.1% of LCS-eligible patients and 27.6% of non-eligible patients reported LDCT prior to diagnosis. In multivariable analysis, no patient factors were significantly associated with prior LDCT completion.

Conclusions: Despite more than half of patients being eligible for LCS at diagnosis, LDCT utilization remained low. Disparities in eligibility across sociodemographic groups suggest that current USPSTF criteria may exclude high-risk populations, contributing to missed opportunities for early detection. These findings underscore the need to refine risk-based screening strategies and address systemic barriers to screening uptake.