Design: Nationwide cross-sectional survey analysis (NHIS 2024)
Population: 5,987 US adults aged 50–80 with a smoking history
Primary outcome: Past-12-month and any lung cancer screening by eligibility group
Effect: Past-year screening 17.8% (USPSTF), 8.0% (ACS-only), 3.9% (neither); ACS-only OR 1.62 (1.12–2.35)

The 2023 American Cancer Society guideline removed the requirement to have quit smoking within the past 15 years, extending lung cancer screening to more former smokers aged 50 to 80 with at least 20 pack-years. This analysis of the 2024 US National Health Interview Survey (5,987 adults, representing 37.5 million with a smoking history) compared screening uptake.

In the past year, 17.8% of USPSTF-eligible adults were screened, against 8.0% of those eligible only under the ACS criteria and 3.9% of those eligible under neither. ACS-only eligibility was associated with higher odds of recent screening than no eligibility (OR 1.62, 95% CI 1.12 to 2.35).

The risk of lung cancer does not return to baseline 15 years after quitting. Former smokers with remote quit dates are easy to overlook because clinicians often record only current smoking. India has no organised lung cancer screening programme, and TB-related lung changes complicate low-dose CT here, but accurate smoking histories are the first step anywhere.

Record pack-years and quit date for every current and former smoker, not just 'ex-smoker'.
A former smoker who quit more than 15 years ago can still be at meaningful lung cancer risk.
Where low-dose CT screening is available, check eligibility against current guidance.
In India, interpret screening CT findings with post-TB changes in mind.

Why it matters

Widening eligibility does little if clinicians do not identify the former smokers it now covers.

The statistics, in plain English

These are self-reported survey data, which can overestimate screening. Odds ratios compare groups after adjustment and do not show why uptake differed.