Only about one in five Americans eligible for lung cancer screening actually get tested, missing a chance to prevent tens of thousands of deaths annually, according to a study published recently in the Journal of the American Medical Association.
The findings have particular significance for South Dakota and the Northern Plains, where rural healthcare access challenges compound the problem of reaching smokers and former smokers who could benefit from early detection, according to researchers at the American Cancer Society.
The study found that just 18.7 percent of eligible individuals reported receiving a chest CT scan to check for lung cancer in 2024, according to data from the National Health Interview Survey. At current screening rates, about 15,000 lung cancer deaths could be prevented over five years, researchers reported. If everyone eligible got screened, that number would jump to more than 62,000 deaths prevented, the study found.
“Increasing current uptake to 100 percent could increase deaths prevented and life-years gained threefold,” researchers wrote in JAMA.
The screening uses low-dose computed tomography scans—similar to a regular CT scan but with less radiation. Patients lie down and move through a donut-shaped X-ray machine while holding their breath, according to the study’s methodology.
Who should get screened? The U.S. Preventive Services Task Force recommends annual screening for people ages 50 to 80 who currently smoke or quit within the past 15 years and have a smoking history of at least 20 “pack-years”—the equivalent of smoking one pack per day for 20 years, or two packs per day for 10 years, according to current guidelines.
The study revealed troubling disparities in who gets screened. Younger eligible people were far less likely to get tested: only 7.9 percent of those ages 50 to 54 reported screening, compared with 22.8 percent of those ages 70 to 80, according to the JAMA study. People with more health problems were more likely to get screened—28.1 percent of those with three or more serious conditions got tested, versus 9.6 percent of those with no major health issues, researchers found.
The study also examined whether screening guidelines should be expanded. Researchers estimated that screening people currently considered ineligible—including those who quit smoking more than 15 years ago but have significant smoking histories—could prevent nearly 30,000 additional deaths and gain 482,000 life-years, according to the findings.
Some organizations have already moved in that direction. The American Cancer Society eliminated the 15-year quit requirement in 2023, and the National Comprehensive Cancer Network followed suit in 2025, according to the study.
For rural states like South Dakota, the challenge extends beyond eligibility. Access to screening facilities, awareness of screening recommendations, and insurance coverage all play roles in the low uptake rates, previous research has shown.
The study’s authors noted limitations, including potential recall bias in self-reported screening and the inability to distinguish between diagnostic and screening CT scans in the survey data.
The research was funded by the American Cancer Society’s Intramural Research Department, according to the study disclosure.
