• Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
• Pulmonary Care and Critical Unit, Massachusetts General Hospital, Boston, Massachusetts.
• Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: cjyang@mgh.harvard.edu.

BACKGROUND: This study sought to evaluate the proportion of patients with lung cancer who would have qualified for lung cancer screening under different eligibility criteria in the Boston Lung Cancer Study (BLCS).

METHODS: BLCS participants with a diagnosis of lung cancer from 1992 to 2024 were identified for analysis. The study evaluated the proportion of patients who would have qualified for screening under the 2021 US Preventive Services Task Force (USPSTF) (age 50-80 years, ≥20-pack-years, <15 quit-years), 20-year duration (age 50-80 years, ≥20-year smoking duration, <15 quit-years), American Cancer Society (age 50-80 years, ≥20-pack-years), National Comprehensive Cancer Network (NCCN) category A (age ≥50 years, ≥20-pack-years), and NCCN category AB (age ≥50 years, ≥20-pack-years or ≥20-year smoking duration) guidelines. The study also evaluated the proportion of patients with a smoking history who were ineligible for screening under the aforementioned guidelines and who had a PLCOm2012 risk score ≥1.0% (referred to as the "PLCOm2012 1.0% risk threshold"). The PLCOm2012 model is a lung cancer risk prediction model developed using data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial.

RESULTS: Of 7186 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. Although the PLCOm2012 1.0% risk threshold identified 52.2% of patients with a smoking history who were ineligible for screening under the USPSTF guideline, the PLCOm2012 1.0% risk threshold excluded the majority of patients with <20 pack-years.

CONCLUSIONS: In this analysis of 7186 patients with lung cancer, only 46.1% would have met the USPSTF guideline. 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.