A new report from the American Cancer Society (ACS) shows that lung cancer screening among high-risk adults in the United States remains strikingly low, even as smoking rates continue to fall. The findings, published in the organization’s first U.S. Tobacco Atlas during Lung Cancer Awareness Month, highlight persistent gaps in prevention efforts.
Cigarette smoking in the U.S. has dropped dramatically over the past half-century—from 42% of adults in 1965 to 11% in 2023. Yet this progress has not translated into widespread use of preventive screening. According to the ACS, only 18.1% of eligible adults were up-to-date with recommended lung cancer screening in 2022. Eligibility includes individuals with a current or significant past smoking history.
Because cigarette smoking remains the leading risk factor for lung cancer, low screening rates represent a significant missed opportunity for early detection. Lung cancer is the leading cause of cancer deaths in the U.S., but outcomes improve substantially when the disease is identified at an early stage.
The report identifies wide geographic variations in screening rates, with the lowest levels occurring across Southern states. These same regions also experience the highest burden of lung cancer incidence and mortality. Limited healthcare access and other structural barriers likely contribute to these disparities, the ACS notes.
More than 80% of lung cancer deaths are attributed to tobacco use, making routine screening for high-risk individuals a critical public health intervention. Low-dose computed tomography (LDCT) remains the recommended method. Updated ACS guidelines from 2023 advise annual LDCT screening for adults ages 50–80 with a 20-pack-year smoking history, regardless of how long ago they quit.
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