Bridging the lung cancer screening eligibility gap: evaluation of guideline applicability in asymptomatic patients

Chen-Ran Wang; Ren-Da Li; Pan Wang; Xue-Si Dong; Hao Zhang; Qing-Peng Zeng; Jia-Xin Xie; Zi-Lin Luo; Xiao-Lu Chen; Ya-Di Zheng; Ji-Bin Li; Yong-Jie Xu; Fei Wang; Ni Li; Feng-Wei Tan; Jie He

doi:10.1016/j.mmr.2026.100020

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Bridging the lung cancer screening eligibility gap: evaluation of guideline applicability in asymptomatic patients

RESEARCH | Updated：2026-05-11

- Bridging the lung cancer screening eligibility gap: evaluation of guideline applicability in asymptomatic patients
- Military Medical Research (2026)
- Affiliations：
  
  Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- Author bio：
  
  *Ni Li, nli@cicams.ac.cn;
  Feng-Wei Tan, tanfengwei@cicams.ac.cn;
  Jie He, hejie@cicams.ac.cn
- Funds：
- DOI：10.1016/j.mmr.2026.100020
  CLC：
- Received：15 April 2025，
  
  Accepted：05 March 2026，
  
  Published：2026-04
- Accepted：
Scan QR Code
Wang CR, Li RD, Wang P, Dong XS, Zhang H, Zeng QP, et al. Bridging the lung cancer screening eligibility gap: evaluation of guideline applicability in asymptomatic patients. Mil Med Res. 2026;13(1):100020.
DOI：

Wang CR, Li RD, Wang P, Dong XS, Zhang H, Zeng QP, et al. Bridging the lung cancer screening eligibility gap: evaluation of guideline applicability in asymptomatic patients. Mil Med Res. 2026;13(1):100020. DOI： 10.1016/j.mmr.2026.100020.

摘要

Abstract

Background:

Early-onset (<50 years) and never-smoker lung cancers are increasing global concerns. The emerging trends challenge current screening guidelines

which focus on adults aged >50 years with heavy smoking histories. We applied the US Preventive Services Task Force (USPSTF) 2021 screening criteria as the primary definition of high-risk individuals eligible for lung cancer screening and assessed the potential optimization of these criteria using real-world lung cancer data in China.

Methods:

In this nationwide

multicenter

hospital-based observational study

we enrolled asymptomatic patients with surgically resected primary lung cancer across 26 tertiary hospitals from January 1

2014 to December 31

2021. Screening eligibility was classified using USPSTF 2021 criteria (aged 50–80 years

≥20 pack-year smoking history

and ≤15 quit-years for former smokers). Temporal trends in eligibility

screening utilization

and mortality risks were assessed through joinpoint regression and Cox proportional hazards models.

Results:

A total of 106

266 asymptomatic patients with lung cancer were enrolled. Among the 102

555 patients with complete age and smoking information

only 8.8% (8985/102

555) met the USPSTF 2021 eligibility criteria. The eligibility proportion declined sharply from 21.6% (350/1617) in 2014 to 6.1% (1737/28

582) in 2021

with the annual percentage change being –17.4% [95% confidence interval (CI) –19.1 to –15.9

]

. Patients with screening utilization

irrespective of eligibility status

demonstrated a higher proportion of stage Ia diagnoses compared with those who were not screened. Screening- ineligible group exhibited 40% lower mortality risk overall [adjusted hazard ratio (

)=0.60

95% CI 0.55–0.66

]

with consistent survival advantages across stage I (adjusted

=0.63

95% CI 0.54–0.74) and stage Ⅲ (adjusted

=0.76

95% CI 0.64–0.90) subgroups.

Conclusions:

Rigid age- and smoking-based criteria overlook substantial at-risk populations in China. Implementing individualized risk stratification is essential to advance equitable lung cancer screening.

关键词

Keywords

references

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