# Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement

Source: https://onco.cc/key-papers/paper-uspstf-lung-cancer-screening-jama-2021/  
OnCo record `paper-uspstf-lung-cancer-screening-jama-2021` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In 2021 the United States task force lowered the age at which lung screening starts from 55 to 50 and halved the smoking history needed from 30 to 20 pack-years, roughly doubling the number of people eligible.

## Summary

The 2021 update of the United States Preventive Services Task Force recommendation on lung cancer screening, replacing the 2013 statement. It recommends annual low-dose computed tomography in adults aged 50 to 80 years with a 20 pack-year smoking history who currently smoke or have quit within the past 15 years, a B recommendation, and says screening should stop once a person has not smoked for 15 years or develops a problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

The widened criteria were driven by a commissioned systematic review and a collaborative modelling study, and by evidence that the 2013 thresholds excluded groups at high risk, Black smokers in particular (paper-aldrich-uspstf-screening-african-american-smokers-jama-oncol-2019).

## Fields

- Kind: Key paper
- Last checked: 2026-09-25
- Tags: lung-evidence
- Journal: JAMA
- Year: 2021
- DOI: 10.1001/jama.2021.1117
- Authors: US Preventive Services Task Force, Krist AH, Davidson KW, et al.
- Findings: Annual low-dose computed tomography is recommended for adults aged 50 to 80 with a 20 pack-year smoking history who currently smoke or quit within the past 15 years (B recommendation).; This replaces the 2013 statement, which recommended screening from age 55 with a 30 pack-year history.; The task force concludes with moderate certainty that annual low-dose computed tomography has a moderate net benefit in people at high risk based on age, cumulative tobacco exposure and years since quitting.; The statement quotes an estimated 228,820 lung cancer diagnoses and 135,720 deaths in the United States in 2020, and an overall five-year survival of 20.5 percent.
- What it means: The document that defines who is offered a scan in the United States, and therefore the document any argument about the screening eligibility gap has to engage with. Eligibility is still defined by pack-years and years since quitting rather than by an individual risk estimate.
- Caveats: Pack-year thresholds are a crude proxy for risk and perform differently across populations; risk-model eligibility was considered in the modelling but not adopted.; Never-smokers are outside the recommendation entirely, so the growing never-smoker disease is not addressed.; A recommendation is not delivery: uptake among eligible people in the United States has remained a small fraction of those covered.; United Kingdom eligibility, the Targeted Lung Health Check programme and NICE positions are on the UK and NHS page for lung cancer and are not restated here.

## Sources

- JAMA 2021: https://doi.org/10.1001/jama.2021.1117
- PubMed: https://pubmed.ncbi.nlm.nih.gov/33687470/
- USPSTF recommendation: lung cancer screening: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening

## Connected records

- key papers: [Evaluation of USPSTF Lung Cancer Screening Guidelines Among African American Adult Smokers](https://onco.cc/key-papers/paper-aldrich-uspstf-screening-african-american-smokers-jama-oncol-2019/), [NELSON: volume-based CT screening reduces lung cancer deaths with fewer false alarms](https://onco.cc/key-papers/paper-nelson-nejm-2020/), [NLST: yearly low-dose CT scans cut lung cancer deaths in heavy smokers](https://onco.cc/key-papers/paper-nlst-nejm-2011/), [Socioeconomic inequalities in lung cancer treatment: systematic review and meta-analysis](https://onco.cc/key-papers/paper-forrest-socioeconomic-inequalities-lung-cancer-treatment-plos-med-2013/)
- roadmaps: [Early detection roadmap: organ screening → blood tests for many cancers](https://onco.cc/roadmaps/early-detection-roadmap/), [Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch](https://onco.cc/roadmaps/lung-cancer-evidence-roadmap/)
- ideas: [Close the United Kingdom lung cancer gaps the UK page names: screening rollout, diagnostic pathway, molecular testing and drug access](https://onco.cc/ideas/idea-lung-uk-screening-testing-and-access-gaps/), [Decide who is screened for lung cancer by individual risk, not by pack-years](https://onco.cc/ideas/idea-lung-screening-eligibility-by-risk-not-pack-years/), [Lung screening eligibility by risk score, not pack-years, including high-risk never-smokers](https://onco.cc/ideas/idea-prev-lung-screening-risk-model-eligibility/), [Treat lung cancer in never-smokers as its own disease, with its own detection programme](https://onco.cc/ideas/idea-lung-never-smoker-disease-its-own-programme/), [Treat the deprivation gradient in lung cancer as a defect in delivery that can be fixed and measured](https://onco.cc/ideas/idea-lung-deprivation-gradient-treated-as-a-defect-in-delivery/)
- cancers: [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/), [Prevention & Risk](https://onco.cc/fronts/prevention/)
- technologies: [Low-dose CT lung screening](https://onco.cc/technologies/low-dose-ct-screening/)
- terms: [Overdiagnosis](https://onco.cc/terms/overdiagnosis/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/), [Trials do not represent the people who get cancer](https://onco.cc/bottlenecks/b-trial-diversity/)
- journals: [JAMA](https://onco.cc/journals/jama/)

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