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Eligibility for lung cancer screening in the United States is based solely on age and smoking history, but multiple studies have shown that a more personalized risk assessment — incorporating other known risk factors — might better identify patients who could benefit from screening (see ).
In the latest such study, researchers in Germany compared the performance of the Nelson criteria — which are similar to the U.S. criteria — against a previously validated risk calculator (PLCOm2012) that takes into account not only age and smoking history but also race, education, personal and family history of cancer, body-mass index, and chronic obstructive pulmonary disease. The study involved 5000 individuals who met the Nelson criteria or were at elevated risk for lung cancer according to the risk calculator (6-year risk, ≥1.6%). All participants underwent initial low-dose CT followed by repeat screening at 1 year.
Slightly more individuals were identified by the risk calculator than by the Nelson criteria (80% vs. 75%). Altogether, 111 cancers were detected; the number detected was higher in the group identified by the calculator than by the Nelson criteria (108 vs. 85 cancers).
Vogel-Claussen J, et al. Effectiveness of NELSON versus PLCOm2012 lung cancer screening eligibility criteria in Germany (HANSE): A prospective cohort study. Lancet Oncol 2025 Dec; 26:1541 10.1016/S1470-2045(25)00490-5.41232542
Comment
Data supporting more refined screening criteria have been available for more than a decade, and Canada is already using the risk calculator described above. Why the United States has not yet adopted a similar approach is unclear, but without a formal change in guidelines, insurers are unlikely to extend their coverage of screening beyond patients who meet current U.S. criteria. Still, the calculator, which is easy to use online, can help inform conversations with patients: An individualized cancer risk estimate might be exactly what someone on the fence needs to feel more comfortable choosing screening.