• Posted November 24, 2025

Under Current Guidelines, Most Lung Cancer Patients Weren't Eligible for Cancer Screening

Under current screening guidelines, almost two-thirds of Americans with lung cancer would not have qualified for the CT chest scans that could have spotted tumors early and extended their lives, new research shows. 

The finding hits home for 38-year-old Carla Tapia, a mother of three from Beltsville, Maryland. She smoked a bit in her youth but had kicked the habit by 18. 

Nevertheless, Tapia first developed respiratory symptoms in 2018, and was diagnosed with inoperable stage 4 lung cancer in 2020. 

After numerous chemotherapies failed, Tapia received a life-saving double-lung transplant at Northwestern Medicine in Chicago in 2024. She’s now attending college back at home in Maryland.

According to Tapia, it's an ordeal timely screening might have prevented.

“I keep hearing stories about young people being diagnosed with lung cancer, and if we could expand the screening guidelines, I believe more lung cancers could be caught at earlier stages, and more lives would be saved,” she said in a Northwestern Medicine news release.

Current guidelines from the United States Preventive Services Task Force (USPSTF) advise annual CT chest scans for adults ages 50 to 80 who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. 

According to study senior author Dr. Ankit Bharat, those eligibility guidelines are too restrictive and miss many people still at risk for the leading cancer killer.

“We moved to universal age-based screening for breast and colon cancer with tremendous success, and we need to move to the same approach for lung cancer,” Bharat said in a Northwestern news release. 

“Chest screening offers something unique — with one low-dose scan, we can assess lungs, heart and bones comprehensively. This baseline scan becomes invaluable for monitoring their health over time,” said Bharat. He is chief of thoracic surgery and executive director of the Northwestern Medicine Canning Thoracic Institute.

Lung cancer can strike anyone, including people who only smoked a short amount of time and even never-smokers. And, as happened in Tapia’s case, nearly 80% of the time lung cancers are first diagnosed in an advanced stage. 

The new study was published Nov. 20 in JAMA Network Open. It tracked nearly 1,000 consecutive patients whose lung cancers were treated at Northwestern Medicine.

Based on their history of smoking (including never-smokers), Bharat’s group estimated that only 35% would have been eligible under USPSTF guidelines to be referred to annual lung CT scanning. 

Women and never-smokers made up a significant number of those who would have been excluded from eligibility for screening, the researchers said.

They believe that moving to a universal screening approach — recommending lung screens for everyone ages 40 to 85 — could spot more tumors early, boost the cost-effectiveness of lung cancer care, and help level the playing field for disadvantaged Americans. 

According to the researchers, a typical lung CT scan takes less than 10 seconds and doesn’t require any intravenous imaging dyes. 

Bharat notes that the leftover effects of the COVID-19 pandemic could mean heightened risks of other lung illnesses among relatively young Americans.

"Nearly six years after the pandemic's start, we're seeing increasing numbers of patients with lung scarring and fibrosis from COVID-19, especially those who get reinfected with respiratory viruses," he said. “The damage compounds with each infection. Early detection through comprehensive screening can help us intervene before these conditions progress to requiring [lung] transplantation.”

Northwestern’s Lung Health Center created a list of patient types who might want to consider lung screening:

• COVID-19 survivors who are having ongoing respiratory issues

• People exposed to contaminants such as wildfire smoke, industrial pollution or high radon levels

• People with family histories of lung disease or pulmonary fibrosis

• Those exposed to secondhand smoke, vaping or marijuana use

• Asian women and other demographics at elevated risk for lung conditions

• Anyone seeking baseline chest health assessment

“We're seeing younger patients with respiratory problems from vaping, environmental exposures and COVID-19 who would never qualify for traditional screening,” said study co-author Dr. Scott Budinger, chief of pulmonary and critical care at the Canning Thoracic Institute.

A more inclusive approach to screening “allows us to catch interstitial lung disease, pulmonary fibrosis, lung cancer and other conditions years before they'd typically be diagnosed,” he said in the news release.

More information

There's more on lung cancer screening at the American Cancer Society.

SOURCE: Northwestern Medicine, news release, Nov. 20., 2025