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Multicenter Study
. 2025 Sep;20(9):1257-1267.
doi: 10.1016/j.jtho.2025.05.009. Epub 2025 May 14.

Risk-Based Lung Cancer Screening in Clinical Practice

Matthew M Rode  1 , Anne-Marie G Sykes  2 , Mark S Allen  3 , Lori A Ingalls  4 , Hamid Rehman  5 , Daniel C Deetz  6 , Susanne C Degen  7 , Janel N Glantz  8 , Adel Zurob  9 , Jamil Taji  10 , Karen L Swanson  11 , Eric A Jensen  12 , Laura C Pappagallo  13 , Margaret M Johnson  14 , Barbara L McComb  15 , Lynn M Loosbrock  16 , Andrew C Hanson  17 , Ping Yang  18 , David E Midthun  19 ; Mayo Lung Screening Program
Affiliations
Multicenter Study

Risk-Based Lung Cancer Screening in Clinical Practice

Matthew M Rode et al. J Thorac Oncol. 2025 Sep.

Abstract

Introduction: Current U.S. lung cancer screening guidelines use only age and smoking history; however, individual risk calculators may better stratify risk.

Methods: In a referred cohort design, we implemented a multisite lung cancer screening program across four states. We screened patients who qualified by either the USPSTF2013 criteria or a PLCOm2012 risk of greater than or equal to 1.34%. Invasive procedures were abstracted retrospectively. We compared the incidence and prevalence of lung cancer among patients who qualified by only USPSTF2013 or PLCOm2012 and along the continuum of prospective lung cancer risk using PLCOm2012.

Results: Of 2471 screened patients, 114 had lung cancer. Furthermore, 84% of all patients and 91% of patients who were diagnosed with having cancer qualified by both criteria. Prevalence of lung cancers were over 7 times higher in the 10% of the cohort with the highest prospective risk than the lowest risk 10%. Incidence of cancers were higher among patients who qualified only by PLCOm2012 (3.6 per 1000 person-years) compared with patients who qualified only by USPSTF2013 (0 per 1000 person-years). Of screen-detected NSCLC, 74% was stage I or II. Three (4.5%) surgical resections were performed for screen-identified nodules which proved to be benign. Overall, 106 patients (4.3%) underwent an invasive intervention due to screening.

Conclusions: Most patients qualified for lung cancer screening by both UPSTSF2013 and PLCOm2012 criteria. Incidence cancers were higher among patients who qualified by PLCOm2012 but not USPSTF2013 criteria. Prevalence and incidence cancer identification increased with prospective risk. Invasive procedures and resections for benign disease were relatively low.

Keywords: Low-dose CT; Lung cancer screening; Pulmonary nodules; Risk-based eligibility.

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Conflict of interest statement

Disclosure Dr. Midthun reports receiving research funding to Mayo Clinic from Biodesix, Delphi Diagnostics, and Guardant Health; receiving royalties from UpToDate; and was formerly on the NCCN Lung Cancer Screening Guideline committee. The remaining authors declare no conflict of interest.

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