{"doi":"10.1001/jamanetworkopen.2025.17149","title":"Reducing Smoking Requirements for Lung Screening to Address Health Disparities in a Community Cohort","abstract":"Importance: Many individuals with lung cancer are not eligible for lung cancer screening (LCS). Race-based and sex-based differences in smoking patterns reduce the effectiveness of LCS criteria. Objective: To assess the value of expanding LCS criteria beyond US Preventive Services Task Force (USPSTF) 2021 guidelines by relaxing cigarette smoking exposure criteria. Design, Setting, and Participants: This cohort study included individuals enrolled in an incidental pulmonary nodule (IPN) program with non-screening-detected, potentially malignant pulmonary nodules, or enrolled in a LCS program from 2015 to 2023. Participants were treated in a community-based health care system serving more than 125 counties in Mississippi, Tennessee, Arkansas, Kentucky, Missouri, and Alabama. Data were examined from October 1, 2024, to May 29, 2025. Exposures: LCS eligibility criteria included USPSTF 2021, Potter criteria (20-year smoking history), and American Cancer Society criteria ([ACS] 20 pack-years, no quit duration), and expansions to 10 years or 10 pack-years. Main Outcomes and Measures: The main outcomes were proportions of individuals eligible for LCS and diagnosis of lung cancer. Characteristics between groups were compared using the χ2 test for categorical variables and the Wilcoxon-Mann-Whitney test for continuous variables. Results: In this study, 43 521 individuals were evaluated, including 13 770 (32%) from LCS and 29 751 (68%) from IPN programs. Of the 29751 individuals in IPN programs, 3840 (13%) were eligible for LCS by USPSTF 2021 criteria, 4905 (16%) by IPN-Potter criteria, 5263 (18%) by IPN-ACS criteria, and 6307 (21%) by IPN-Potter-ACS criteria. There were 1103 additional individuals eligible by IPN-Potter criteria (606 female [55%] and 382 Black [35%]), 1423 by IPN-ACS criteria (628 female [44%]; 237 Black [17%]), and 2467 by IPN-Potter-ACS criteria (1200 female [49%]; 615 Black [25%]). There were significant differences in the number of additional eligible individuals who were female (55% vs 48%; P < .001) and Black (35% vs 22%; P < .001) between the IPN-Potter and USPSTF 2021 criteria. Lung cancer was diagnosed in 504 of 13 770 of LCS enrollees (4%) and 1714 of 29 751 of IPN enrollees (6%), including 872 of 4905 (18%) eligible by IPN-Potter criteria, 955 of 5263 (18%) by IPN-ACS criteria, and 1051 of 6307 (17%) by IPN-Potter-ACS criteria. The additional eligible individuals with lung cancer in IPN programs who were female included 70 of 128 (55%) by IPN-Potter criteria, 89 of 208 (43%) by IPN-ACS criteria, and 143 of 304 (47%) by IPN-Potter-ACS criteria, with statistically significant differences between the IPN-Potter criteria and USPSTF 2021 criteria (55% vs 48%; P < .001). The additional eligible individuals who were Black included 50 of 128 (39%) by IPN-Potter criteria, 32 of 208 (15%) by IPN-ACS criteria, and 73 of 304 (24%) by IPN-Potter-ACS criteria, with statistically significant differences between IPN-Potter criteria and IPN-USPSTF 2021 criteria (39% vs 22%; P < .001). When LCS criteria were expanded to individuals older than 50 years who had smoked for 10 years or 10 pack-years, 7993 of 29 751 individuals (27%) from IPN programs would have been eligible. Among these, 1251 of 7993 (16%) were diagnosed with lung cancer. Conclusions and Relevance: In this cohort study, changing smoking criteria from 20 pack-years to a 20-year smoking history was associated with improved access to LCS while maintaining diagnostic efficiency. Expansion to individuals with a 10-year or 10 pack-years smoking history should be explored.","journal":"JAMA Network Open","year":2025,"id":532575,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9553,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":356833,"name":"Wei Liao","orcid":"0000-0001-8981-0795","position":1,"is_corresponding":false},{"id":1414142,"name":"J. Goss","orcid":null,"position":2,"is_corresponding":false},{"id":1144214,"name":"Talat Qureshi","orcid":null,"position":3,"is_corresponding":false},{"id":389948,"name":"Sara Johnson","orcid":"0000-0001-8796-1549","position":4,"is_corresponding":false},{"id":1413708,"name":"Amanda Harris","orcid":"0000-0002-6953-7370","position":5,"is_corresponding":false},{"id":1151985,"name":"Kourtney R. Dortch","orcid":"0009-0006-6679-313X","position":6,"is_corresponding":false},{"id":1143827,"name":"Carrie Fehnel","orcid":"0009-0003-1453-7896","position":7,"is_corresponding":false},{"id":1413709,"name":"Sora Ely","orcid":"0000-0002-1012-1063","position":8,"is_corresponding":false},{"id":351813,"name":"Meredith Ray","orcid":"0000-0001-5312-3774","position":9,"is_corresponding":false},{"id":274182,"name":"Raymond U. Osarogiagbon","orcid":"0000-0001-9427-8545","position":10,"is_corresponding":false},{"id":1145155,"name":"Matthew P. Smeltzer","orcid":"0000-0003-1366-9267","position":0,"is_corresponding":true}],"reference_count":30,"raw_metadata":null,"created_at":"2026-07-19T02:51:23.237536Z","pmid":"40553471","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}