Eligibility and Prognostic Performance of Smoking Duration–Based Versus Pack-Year–Based U.S. National Lung Cancer Screening Criteria Across Racial and Ethnic Groups

BACKGROUND: The U.S. Preventive Services Task Force expanded lung cancer (LC) screening eligibility in 2021 (USPSTF-2021) by decreasing the minimum number of smoking pack-years from 30 to 20. Underrepresented minorities still experience disparities in screening eligibility. OBJECTIVE: ) model (secondary outcome) across diverse racial and ethnic groups. DESIGN: Prospective, population-based Multiethnic Cohort linked to SEER (Surveillance, Epidemiology, and End Results) registries. SETTING: California and Hawai'i, with recruitment from 1993 to 1996. PARTICIPANTS: 105 261 adults aged 45 to 75 years with a history of smoking. MEASUREMENTS: Hypothetical eligibility and prognostic performance (sensitivity and specificity) in detecting 6-year LC. RESULTS: 6-year threshold of 1.1% improved both sensitivity and specificity in the overall cohort. However, it widened the eligibility gap between Latinos and Whites (14.4% vs. 31.3%) and demonstrated lower sensitivity in Latinos than duration-based criteria (59.7% vs. 69.8%). LIMITATIONS: Cohort geography and enrollment period may limit generalizability. Overdiagnosis was not measured. CONCLUSION: Compared with USPSTF-2021, the 30-year duration-based criteria could reduce the eligibility gaps among African Americans and Latinos relative to Whites while improving 6-year LC detection sensitivity across all races. PRIMARY FUNDING SOURCE: National Institutes of Health.