Medscape finds 25% lung screening

Medscape reported on May 13 that only about one in four U.S. adults eligible for lung cancer screening are getting it, citing new research and interviews that pointed to confusing eligibility rules, stigma tied to smoking and uncertainty about how screening works. The figure tracks with a JAMA Internal Medicine study published on April 27 that found 24.5% of eligible adults were up to date with screening in 2024. Annual low-dose CT screening is recommended for high-risk adults because lung cancer remains the leading cause of cancer death in the United States. But the latest data show screening is still reaching a minority of the people federal guidelines are meant to capture. ### Who counts as eligible for screening right now? The U.S. Preventive Services Task Force recommends annual low-dose CT screening for adults ages 50 to 80 with at least a 20 pack-year smoking history who currently smoke or quit within the past 15 years. The task force issued that updated recommendation in 2021, expanding the pool beyond the older 55-to-80 and 30-pack-year standard. (medscape.com) CMS uses a slightly narrower age range for Medicare coverage. Medicare says Part B covers annual lung cancer screening for asymptomatic beneficiaries ages 50 to 77 who have a 20 pack-year history, currently smoke or quit within the past 15 years, and have an order from a healthcare provider after a counseling visit. (uspreventiveservicestaskforce.org) The American Cancer Society moved further in 2023. ACS says adults ages 50 to 80 with a 20 pack-year history who currently smoke or formerly smoked should be referred for yearly low-dose CT screening, without the 15-year cutoff since quitting that remains in the USPSTF and Medicare rules. (cms.gov) ### How low is uptake, and who is missing out? Todd Burus of the University of Kentucky and colleagues reported in JAMA Internal Medicine that 24.5% of eligible adults were up to date on screening in 2024. The study compared 2024 Behavioral Risk Factor Surveillance System data with 2022 and found a roughly 6 percentage point increase over that period. (cancer.org) The same study found large differences by coverage type. Adults with military-related health coverage had the highest screening rate at 39%, compared with 19% among those with private insurance, while uninsured adults were screened at about 6%, with little change from 2022. American Cancer Society researchers, using a different national survey, estimated in November 2025 that 18.7% of eligible people were up to date with screening in 2024. (medicalxpress.com) The ACS said that if screening reached 100% of eligible people, about 62,110 lung cancer deaths over five years could be prevented, versus 14,970 deaths prevented at current uptake. ### Why do doctors keep saying the rules are confusing? Medscape said clinicians pointed to a mix of overlapping standards from USPSTF, Medicare and ACS, along with paperwork and counseling requirements, as barriers that can slow referrals and discourage patients. That confusion is built into the policy landscape: a patient can meet ACS guidance but still fall outside Medicare’s quit-time rule or age cutoff. (pressroom.cancer.org) CMS also requires a counseling and shared decision-making visit before a beneficiary’s first screening CT. Medicare says the visit must document eligibility, discuss benefits and harms, address adherence and smoking cessation, and support the order for the scan. ### What does low screening mean once patients do enter the system? (medscape.com) The American Lung Association said in its 2024 “State of Lung Cancer” report that only 16.0% of eligible people were screened in 2022, even after the 2021 expansion of federal recommendations. The group said people of color diagnosed with lung cancer are less likely to be diagnosed early and more likely to receive no treatment. (cms.gov) A 2025 JAMA research letter from Massachusetts General Hospital researchers said lung cancer screening “could potentially save tens of thousands of lives annually” but noted that uptake remained low, with only 18% of eligible individuals screened in 2022. The authors also wrote that tobacco use is more common among adults with low socioeconomic status and with mental illness, groups that often face weaker access to preventive care. (lung.org) That pattern matters for downstream diagnosis. When screening penetration stays low, more patients are likely to arrive for workup after symptoms appear rather than through a scheduled low-dose CT program — an inference supported by the cited evidence on low uptake and later-stage inequities, though the exact effect on cytology or biopsy volume will vary by hospital and referral base. (jamanetwork.com) ### What happens next? The April 27, 2026 JAMA Internal Medicine paper gives health systems and public programs a fresh national benchmark for 2024 screening rates. Medscape’s May 13 report said clinicians are focusing on simpler eligibility checks, patient navigation and clearer communication to raise adherence among people who already qualify. (lung.org) Medicare’s current coverage rules remain in force for claims dating from February 10, 2022, and ACS’s broader 2023 guideline remains available to clinicians deciding whom to refer for annual low-dose CT. Those two reference points — along with the newer JAMA Internal Medicine data — are likely to shape the next round of screening outreach and policy debate. (cms.gov) (jamanetwork.com)