Contemporary trends in early-stage non–small cell lung cancer diagnosis and disparities, 2018–2022.

10550 Background: Early detection of non-small cell lung cancer (NSCLC) improves survival. We evaluated stage trends in adults aged 50-80 with NSCLC in SEER 2018-2022 after the 2021 screening expansion and the COVID-19 pandemic. Methods: We included 112,183 SEER cases aged 50-80 with primary NSCLC from 2018-2022. Histology was classified as adenocarcinoma, squamous, large cell or other/unknown. Stage at diagnosis was categorized as early (0-II) versus late (III-IV). Early-stage proportions were calculated by year, sex, race, age, income quartile, rurality and histology. Trends were tested using the Cochran–Armitage test. Multivariable logistic regression evaluated associations with early-stage diagnosis. To adjust for changing eligibility, NHIS 2018-2022 data were used to estimate screening-eligible shares by age-sex-race strata and standardize stage distributions. Results: Among 112,183 patients (median age 69; 56% male), 39,023 (34.9%) were early stage. Early-stage diagnoses increased modestly from 34.4% in 2018 to 35.6% in 2022, with a dip to 33.8% in 2020 (Table 1). Women had higher early-stage rates (~38%) than men (~32%), and White patients had higher rates (~37%) than Black or American Indian/Alaska Native patients (~29%). Logistic regression showed male sex (OR 0.78) and non-adenocarcinoma histology (ORs 0.16-0.25) were associated with lower odds of early detection; income quartile and rurality were not significant. Eligibility-standardized analyses produced similar trends, suggesting limited impact of the 2021 screening expansion to date. Conclusions: Between 2018 and 2022, early-stage NSCLC detection in SEER improved only slightly. Sex and racial disparities persisted. Enhanced outreach, particularly to men and racial/ethnic minorities, and broader low-dose computed tomography implementation are needed to accelerate stage migration. Early-stage NSCLC diagnoses by year (ages 50–80). Year Total cases Early-stage cases Early-stage proportion* 2018 23,482 8,069 34.36% 2019 24,061 8,427 35.02% 2020 20,633 6,965 33.76% 2021 22,099 7,772 35.17% 2022 21,908 7,790 35.56% *The Cochran–Armitage test indicated a statistically significant upward trend (p < 0.05), but the absolute increase was modest.