Adults aged 75-80 years benefit from lung cancer screening just as much as younger patients if they are fit enough for surgery, according to a new study.
Researchers found that when those older adults underwent surgery for screen-detected lung cancer, their overall survival rate was comparable to that of relatively younger patients.
The results challenge long-standing age limits on national lung screening programs and call for a shift toward tailoring eligibility based on surgical fitness rather than age alone, said Patrick Goodley, PhD, of Manchester University NHS Foundation Trust, Manchester, England.
The study was presented at World Conference on Lung Cancer (WCLC) 2025 in Barcelona, Spain.
Currently, many national lung cancer screening programs, including the UK’s, screen up to age 74, even though about half of lung cancers are diagnosed in people older than that. In contrast, US guidelines call for screening certain current and former smokers until age 80. However, evidence to support that broader age range has been limited, leaving uncertainty as to whether older patients truly benefit from routine scans.
To investigate, Goodley and colleagues compared outcomes between adults aged 55-74 years and those aged 75-80 years diagnosed with screen-detected lung cancer in two UK targeted screening programs — the Yorkshire Lung Screening Trial and the North & East Manchester Lung Health Check program.
In the 55-74 age group, 22,481 routine screenings were conducted, with 390 cancers detected; in the 75-80 age group, 7000 screenings were done, detecting 195 cancers. Overall, screening yielded 60% more cancers per screening round among the older adults (2.8% vs 1.7%).
“So this age group is a very fertile ground for detecting cancers,” Goodley said during a press briefing.
In both the younger and older groups, most cancers detected were stage I (69% and 70%, respectively), and most patients got early curative-intent treatment (90% and 82%). Older patients, however, were less likely to undergo surgical resection (41% vs 58%).
In terms of overall survival, looking at all screen-detected cancers, the older group had a relatively lower survival at 4 years (56% vs 66%). However, that gap “disappears,” Goodley said, when looking only at patients who underwent surgery. At 4 years, survival was 84% among older patients treated surgically and 82% among their younger counterparts.
The results, Goodley said, show that it’s “feasible to screen up to age 80, the yield is high, and you might get even more benefit out of doing so, if you’re selective for who you screen based on surgical fitness.”
Discussant for the study, Pan-Chyr Yang, MD, PhD, with National Taiwan University, Taipei, Taiwan, emphasized the “fitness” piece. He noted that patients aged 75 years or older may be at greater risk for treatment-related adverse events, have a higher risk for death from competing causes, and will typically see fewer life-years gained from lung cancer screening than relatively younger patients.
Screening up to age 80, Yang said, “is justified only in fit patients with curative treatment access.”
At the same time, there would be challenges to introducing such selectivity into national lung screening programs. Goodley said it will require new systems for evaluating patients’ surgical fitness ahead of screening. “You can’t sit everyone in front of a thoracic surgeon to do so,” he pointed out.
While logistical challenges exist, patient advocate Shani Shilo, from the Israel Lung Cancer Foundation, said the study supports a move away from current age limits, and toward a more individualized approach.
“Progress in lung cancer isn’t only about discovering new medicines,” she said. “It’s about using the tools we have in smarter, kinder and more personalized ways.”
This study had no commercial funding. Goodley, Shilo, and Yang had no disclosures.