Annals of Internal Medicine December 2026 Eligibility and Prognostic Performance of Smoking Duration–Based Versus Pack-Year–Based U.S. National Lung Cancer Screening Criteria Across Racial and Ethnic Groups

This research evaluates whether using smoking duration instead of the current pack-year criteria for U.S. national lung cancer screening could improve equity across different racial and ethnic groups. The study utilized a multi-ethnic cohort to compare the eligibility rates and prognostic performance of the 2021 U.S. Preventive Services Task Force (USPSTF-2021) guidelines against a proposed 30-year smoking duration requirement. The findings indicate that the 30-year duration criteria significantly reduces the screening eligibility disparities between African Americans and Latinos relative to White participants, while also modestly increasing the sensitivity for detecting lung cancer within six years across all groups. Although a risk-based model was also tested and performed well overall, it ultimately widened the eligibility gap for Latino populations, supporting the conclusion that duration-based criteria are a more equitable alternative for lung cancer screening.