Binary risk.

Despite recent broadening of lung cancer screening criteria, this cohort study of those 65 years and older suggests any smoking history is the kicker when determining pre-test probability. It took a look at lung cancer incidence among those for whom low-dose CT screening is not currently recommended. Incident lung cancer occurred in 5 of 100 current smokers with less than 20 pack-years of smoking (5%) and 26 of 516 former smokers with 20 or more pack-years of smoking with 15 or more years of smoking cessation (5%) compared to 10 of 1973 never smokers (0.5%). In other words, any smoking history, even in less total duration or with a longer interval since cessation than current guidelines allow, conferred 10x the risk for developing lung cancer than the general population supporting a more nuanced approach to lung cancer screening. | Faselis, JAMA Oncol 2022

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