About 13.5% of US adults aged 50 to 80 with a smoking history qualify for a yearly lung cancer scan only under the American Cancer Society’s 2023 guideline, and just 8.0% of them had one in the past year, according to a nationwide study published September 18, 2026 in the journal CHEST. They smoked at least 20 pack-years and quit more than 15 years ago, a group the federal criteria still leave out.
If that describes you, there is something concrete to do: ask your doctor whether a yearly low-dose CT makes sense, and ask what your plan will pay before you book it. Qualifying under a medical society’s guideline is not the same as qualifying under the federal criteria, which still require that you quit within the last 15 years.
The study counted who is eligible and who showed up, not whether anyone lived longer, so it cannot tell you a scan will help you. That call belongs with your doctor. What does a life spent depending on your lungs look like? One man lived 72 years inside an iron lung.
Key takeaways
- The American Cancer Society dropped the rule that you must have quit within 15 years to qualify for a yearly lung scan. The federal task force still has it.
- Among adults who qualify only under the newer ACS rule, 8.0% were scanned in the past year, versus 17.8% of those meeting the federal criteria.
- Insurance coverage tracks the federal criteria, so the newly eligible can be told to get a scan and then billed.
What the study found
Researchers analyzed the 2024 National Health Interview Survey, covering 5,987 adults aged 50 to 80 who smoke or used to, representing about 37.5 million US adults. About 35.2% met the 2021 US Preventive Services Task Force criteria, 13.5% met the 2023 ACS criteria only, and 51.2% met neither.
Scanning in the past 12 months ran 17.8% in the federal group, 8.0% in the ACS-only group, and 3.9% among those eligible under neither guideline.
In plain counts, that is a gap of about 4 people per 100 between the ACS-only group and those eligible under neither rule. After adjustment, the ACS-only group had about 62% higher odds of a recent scan (odds ratio 1.62), though the estimate is wide, from 12% higher to more than double (95% CI 1.12 to 2.35). Federally eligible adults had about 4.5 times the odds (odds ratio 4.54, very likely between 3.4 and 6 times higher).
One result cuts against the optimistic reading. The ACS-only group showed no increase in having ever been screened, so whatever is happening for them looks recent.
Dr. Kumar’s take
The 2023 ACS guideline dropped the 15-year quit line that the 2021 federal criteria still apply. Nothing changes in a former smoker’s chest on the fifteenth anniversary of the last cigarette. In this survey, about 13 in every 100 adults aged 50 to 80 with a smoking history sat in the gap between the two rules, and only 8 in 100 of them had been scanned in the past year.
The trap a wire summary would skip is the billing one. The ACS says a 70-year-old who quit in 1998 should be screened. The 2021 federal criteria still say no, because they count only people who quit within the last 15 years. An ACS-only patient can be told to get the scan, get it, and then get a bill.
This study also proves less than the framing suggests. It is a one-time survey, not a trial. It counted who qualified and who reported a recent scan, not whether those scans changed how long anyone lived.
What it means for you
If you smoked the equivalent of a pack a day for 20 years or more, are between 50 and 80, and quit more than 15 years ago, you are in the group this study is about. Raise it at your next visit and ask two questions in the same breath. Is a yearly low-dose CT right for me given my age and my other health problems? And what will I be charged? Call your insurer or the imaging center’s billing line and ask whether they cover screening under the ACS criteria. Some plans do, some do not.
A scan can also find something that turns out to be nothing, which means more scans, sometimes a biopsy, and months of worry. That belongs in the conversation too. If you still smoke, none of this replaces quitting. Can tai chi or mindfulness ease the fatigue and pain of cancer treatment? One trial tested it.