Why 4 in 5 Eligible Adults Miss Lung Cancer Screening

Cancer death rates in the United States fell for both men and women from 2019 to 2023, driven largely by accelerated progress against lung cancer, according to the 2026 Annual Report to the Nation on the Status of Cancer.^1,2

Lung cancer death rates decreased 4.7% per year among males and 3.0% per year among females during that period, gains researchers attributed in part to a roughly 50% drop in smoking since the early 2000s.³ Still, lung cancer remains the leading cause of cancer death in the US, and researchers noted that sustaining progress may depend on access to early cancer detection, timely diagnosis, and state-of-the-art treatment.²

In an interview with The American Journal of Managed Care^® (AJMC^®), Jane Henley, MSPH, an epidemiologist in CDC's Division of Cancer Prevention and Control and the report's lead author, talked about what's behind the decline, where the lung cancer burden remains highest, and why so few eligible adults are getting screened.

This interview has been lightly edited for clarity.

AJMC: The report frames this year's special topic as “21st-century progress against lung cancer." Over that roughly 20-year span, how much of the mortality decline do you attribute specifically to falling smoking rates vs improvements in early detection and treatment? Is it possible to disentangle those 2 drivers in registry data, or are they too intertwined?

Henley: We did not examine the contribution of different drivers to mortality decline in this report. In the discussion, we reference 2 recent studies that have looked at this topic.^4,5 Goddard et al. used models developed by the Cancer Intervention and Surveillance Modeling Network (CISNET). They found that about 2% of averted lung cancer deaths were due to treatment advances in the presence of prevention and/or screening, and 98% were due to prevention and/or screening only.

They did not disentangle prevention and screening but stated that the model did not quantify emerging interventions with low uptake during the study period, like lung cancer screening, suggesting that with time, mortality would be further decreased.

For an individual person, I think each of these attributes—prevention, early detection, and state-of-the-art treatment—is important. Health care providers can help by talking with their patients about tobacco use and lung cancer screening. They can make sure their patients with lung cancer get timely, appropriate care, including biomarker testing.

AJMC: Lung cancer is still the leading cause of cancer death even after this progress. Given your background in tobacco-related cancer surveillance, what does the remaining burden look like now? Is it concentrated in specific populations, regions, or smoking histories that haven't benefited as much from the decline?

Henley: We are seeing differences in lung cancer incidence and mortality among several different groups. For example, using the current data in our United States Cancer Statistics: Data Visualizations tool, there are large differences by state, with incidence rates ranging from 15 to 83 and death rates ranging from 10 to 47 [per 100,000 people]. Lung cancer incidence and death rates are higher among people who live in rural counties compared with people who live in metropolitan counties. CDC has tools and resources for clinicians and health systems to help integrate tobacco treatment into routine clinical care.

AJMC: The release notes that sustaining progress "may depend on access to early cancer detection, timely diagnosis, and state-of-the-art treatment." Beyond smoking reduction, which of those access gaps worries you most right now, and does the data show where those gaps are widest?

Henley: It's concerning that so few eligible people get screened for lung cancer. Lung cancer screening is proven to reduce mortality and is recommended for adults at high risk of developing lung cancer because of their age and smoking history. Data from CDC's National Health Interview Survey show that 4 out of 5 adults eligible for screening did not get it.

[The share who were not screened] is higher among adults in their 50s, women, Hispanic adults, and healthier adults (those who did not report having a chronic condition). Many people don't know about lung cancer screening or that it is covered by insurance. Health care providers can talk with their patients aged 50 to 80 years with a history of smoking about getting screened. Screening can reduce deaths by finding lung cancer at an early stage, when treatment is more effective. We could save more lives with greater screening uptake.

References

1. Henley SJ, Siegel DA, Firth AU, et al. Annual report to the nation on the status of cancer, featuring 21st century progress against lung cancer. Cancer. Published online September 22, 2026. doi:10.1002/cncr.70577

2. Annual report to the nation: progress against lung cancer drives down cancer mortality. News release. CDC. September 22, 2026. Accessed September 25, 2026. https://www.cdc.gov/media/releases/2026/annual-report-to-the-nation-progress-against-lung-cancer-drives-down-cancer-mortality.html

3. McCrear S. Lung cancer progress drives down US cancer death rates. AJMC. September 22, 2026. Accessed September 25, 2026. https://www.ajmc.com/view/lung-cancer-progress-drives-down-us-cancer-death-rates

4. Goddard KAB, Feuer EJ, Mandelblatt JS, et al. Estimation of cancer deaths averted from prevention, screening, and treatment efforts, 1975–2020. JAMA Oncol. 2024; 11(2):162. doi:10.1001/jamaoncol.2024.5381

5. Islami F, Nargis N, Liu Q, et al. Averted lung cancer deaths due to reductions in cigarette smoking in the United States, 1970–2022. CA Cancer J Clin. 2025;75(3):216-225. doi:10.3322/caac.70005