Age cutoffs for lung cancer screening vary worldwide, ranging from 70 in Australia to 80 in the United States. Several countries, including the United Kingdom, Poland, and Korea, set the upper limit at 74, the median age of lung cancer diagnosis. However, because most trials exclude patients older than 74, the question remained: Do adults between 75 and 80 benefit from screening as much as those aged 55 to 74?
Patrick Goodley, PhD, addressed this question in a multicenter cohort study presented during the second Presidential Symposium at the 2025 World Conference on Lung Cancer (WCLC) on Monday, September 8. The analysis compared screening cutoffs of two age cohorts, using data from two United Kingdom programs: the Yorkshire Lung Screening Trial (YSLT)1 and the North & East Manchester Lung Health Check (NEM-LHC).2 Both programs began initiatives in 2019 and recruited individuals with a history of smoking.
Expanding Lung Cancer Screening Age to Benefit Older Adults
Hear from Dr. Patrick Goodley, PhD, who shares new data on screening through age 80, presented during the second Presidential Symposium at WCLC 2025. Learn More
Of approximately 30,000 screenings performed, about 6,000 cancers were detected, with a higher yield in the older age group. “If you want to detect cancers, this older age range is the place to do it,” Dr. Goodley said, citing a 60% increase in detection among the older cohort, compared with the younger group.
Stage distribution was similar in both groups, with about 80% of cases diagnosed at stages I and II.
“Early-stage distribution is great, but you need to be able to translate that into curative treatment if you are going to help people,” Dr. Goodley said.
Roughly 90% of patients in both age groups received curative-intent treatment, although surgical resection rates were lower in older adults (42% vs. 58% in the 55–74 age group; p < 0.001).
All-cause mortality was higher in the older group (hazard ratio [HR] 1.54; 95% confidence interval [CI]: 1.12–2.10; p < 0.001), with 44% mortality at 4 years compared with 34% in the younger group. However, no survival difference was observed in the subgroup with surgical resection (HR 1.00 [0.47–2.11]), with 4-year mortality of 16% versus 18%, respectively.
The findings suggest that expanding the upper age limit for lung cancer screening to 80 could be beneficial, with the potential value of screening selection based on surgical fitness. Dr. Goodley acknowledged the challenges of refining eligibility within the public and pointed to tools to help overcome such challenges.
“We are trying to develop a tool that any healthcare practitioner could use to predict surgical fitness at the point of eligibility assessment,” Dr. Goodley said. He added that electronic healthcare data could also enrich screening populations.
“All in the name of providing a more equitable screening program—reaching people who stand to benefit and moving beyond simplistic age limits to maximize efforts.”
References
- 1. Crosbie PA, Gabe R, Simmonds I, et al. Yorkshire Lung Screening Trial (YLST): protocol for a randomised controlled trial to evaluate invitation to community-based low-dose CT screening for lung cancer versus usual care in a targeted population at risk. BMJ Open. 2020;10(9):e037075. Published 2020 Sep 10. doi:10.1136/bmjopen-2020-037075
- 2. Goodley P, Balata H, Alonso A, et al. Invitation strategies and participation in a community-based lung cancer screening programme located in areas of high socioeconomic deprivation. Thorax. 2023;79(1):58-67. Published 2023 Dec 15. doi:10.1136/thorax-2023-220001
