Gains, yes. But only 1 in 4 who are eligible get screened for lung cancer

After years of slow progress, lung cancer screening rates in the United States are finally ticking upward, but not fast enough to close persistent gaps. New research, published in JAMA Internal Medicine last month shows that approximately 1 in 4 eligible adults were up-to-date with recommended screening in 2024, marking a 6-percentage point increase since 2022. Still, improvements were uneven across populations, with little to no progress among several racial and ethnic groups and among uninsured individuals, highlighting the need for more targeted outreach and stronger screening infrastructure.

Lung cancer remains the leading cause of cancer-related death in the United States, in part because it is often diagnosed at an advanced stage. To improve early detection, the U.S. Preventive Services Task Force recommends annual screening with low-dose computed tomography scans for high-risk individuals, including those aged 50 to 80 years with a significant smoking history. Although screening has been shown to reduce mortality, participation has historically lagged behind that of other cancer screenings, raising concerns about missed opportunities for early intervention.

“Optimizing lung cancer screening programs to improve effectiveness is the best way to continue to drive down mortality from lung cancer,” says study co-author Timothy Mullett, M.D., MBA, medical director of the University of Kentucky Markey Cancer Center.

To examine screening trends, Todd Burus, Ph.D., assistant professor at UK College of Medicine, and colleagues analyzed data from the 2024 Behavioral Risk Factor Surveillance System, a large, population-based survey of U.S. adults. The study included 26,104 respondents who met screening eligibility criteria, representing 12.3% of U.S. adults aged 50 to 80 years. Investigators assessed self-reported screening within the past year and compared results with 2022 data to evaluate changes over time.

Overall, 24.5% of eligible adults reported being up-to-date on lung cancer screening in 2024. Screening rates increased with age, rising from 11.3% among adults aged 50 to 54 years to just over 31% among those aged 75 to 79 years. Insurance status was strongly associated with screening uptake: individuals with military-related coverage had the highest screening prevalence at 39.05%, followed by those with Medicare and Medicaid, while uninsured individuals had markedly lower rates at just 6.07%.

Encouragingly, screening prevalence improved across most subgroups, with no overall declines observed. However, gains were not universal. The study found no significant change in screening rates among Hispanic, Asian or Black adults, nor among uninsured individuals or the oldest eligible age group. Geographic variation was also notable, with state-level screening prevalence ranging from 13.4% in South Dakota to 38.4% in Massachusetts, and the highest rates concentrated in the Northeast.

Co-author Timothy Mullett said the findings point to steady progress in lung cancer screening adherence, calling the trend “exciting,” even though screening rates remain significantly lower than other cancer screening rates. Fewer than half of eligible individuals currently undergo screening, he said, leaving considerable room for improvement.

The authors emphasized that, although progress is being made, adherence to annual lung cancer screening remains “low and uneven,” pointing to structural and systemic barriers that continue to limit uptake.

“Our most significant improvement will be to enhance the role of lung cancer screening programs and unburden primary care from the responsibility of following up on referred patients,” Mullett said. He added that more effective screening programs could provide “enhanced navigation and communication with patients to be sure that annual scans are accomplished.” Effective programs can also help patients access tobacco treatment resources and move those with suspicious nodules into treatment more efficiently, he said.

At the same time, Mullett urged caution about expanding lung cancer screening eligibility criteria without stronger supporting evidence. “We have to be careful in considering expansion of eligibility criteria,” he said, noting that the strongest data still come from the National Lung Screening Trial in people of certain ages with substantial tobacco exposure. Evidence is less established for other potentially high-risk groups, including firefighters, coal workers and people with radon exposure, he said.

Broadening eligibility too quickly could weaken adherence to existing guidelines and create challenges for future policy decisions, Mullett added. “Further research should be undertaken to establish evidence for expanding the criteria,” he said.

For managed care stakeholders, the findings reinforce a familiar but urgent message: increasing screening uptake will require not just broader awareness, but sustained investment in systems that make screening accessible for patients most at risk.