Experts have recommended that screening for heart attack risk in men should start earlier than for women, warning that cardiovascular disease (CVD) starts climbing when men are in their mid-30s.

For their recent study, which was published in the Journal of the American Heart Association, the US-based researchers followed the health of 5 112 people for an average of around 34 years. As the participants were healthy and aged 18-30 when the study started in the mid-1980s, the study team could chart cases of CVD (including strokes and heart failure) over time.

According to the data, 35 is the critical age when disparities between male and female CVD risk start to appear. Most of the difference is driven by coronary heart disease (CHD), the most common cause of heart attacks, where fatty deposits clog up arteries, blocking blood flow.

“That timing may seem early, but heart disease develops over decades, with early markers detectable in young adulthood,” said epidemiologist Alexa Freedman from America’s Northwestern University.

“Screening at an earlier age can help identify risk factors sooner, enabling preventive strategies that reduce long-term risk.”

After accounting for other contributory factors, including blood pressure, cholesterol, blood sugar levels, smoking status, physical activity, and body weight, the gap was lessened – but it didn’t disappear, suggesting there’s more to the story.

The data showed that men reach a 5% incidence level of cardiovascular disease about seven years earlier than women, or 50.5 years versus 57.5 years, on average. For CHD specifically, a 2% incidence is reached in men a decade before women.

For stroke risk, there was little difference between men and women, and the gap for heart failure (where the heart isn’t pumping as well as it should be) started to emerge later in life, findings upon which future studies may be able to build.

“This was still a relatively young sample – everyone was under 65 at last follow-up – and stroke and heart failure tend to develop later in life,” Freedman said.

While the study didn’t go into the reasons for the discrepancy between men and women in much detail, differences in sex hormones and cholesterol levels may be partly responsible.

The 10-year difference in CHD risk between the sexes has been reported before, but this new study analysed more recent data and expanded upon previous analyses to include multiple kinds of cardiovascular disease.

Given that women are more likely to regularly visit health professionals for check-ups, and men have such a significant head start when it comes to heart attack risk, the researchers are hoping to see more done to encourage men to get their heart health assessed at an earlier age.

“Our findings suggest that encouraging preventive care visits among young men could be an important opportunity to improve heart health and lower cardiovascular disease risk,” said Freedman.

Study details

Sex Differences in Age of Onset of Premature Cardiovascular Disease and Subtypes: The Coronary Artery Risk Development in Young Adults Study

Alexa Freedman, Laura. Colangelo, Hongyan Ning et al.

Published in Journal of the American Heart Association on 28 January 2026

Abstract

Background
Historical data indicate men develop coronary heart disease (CHD) 10 years before women. However, whether this sex gap persists in a contemporary sample amid changing cardiometabolic risk profiles, and whether differences exist for other cardiovascular disease (CVD) subtypes (ie, stroke, heart failure), is not known.

Methods
Data are from the CARDIA (Coronary Artery Risk Development in Young Adults) study, a prospective multicentre cohort study. US adults aged 18 to 30 years enrolled in 1985 to 1986 and were followed through August 2020. Sex differences in the cumulative incidence functions of premature CVD (onset <65 years), overall and for each subtype (CHD, heart failure, stroke), were compared using Gray’s test.

Results
Among 5112 participants (54.5% female, 51.6% Black) with a mean age of 24.8 years (SD: 3.7) at enrolment and a median follow‐up of 34.1 years (interquartile range, 33.8–35.7), men had a significantly higher cumulative incidence of CVD, CHD, and heart failure (P<0.05 for all), with no difference in stroke (P=0.63). Men reached 5% incidence of CVD 7.0 years earlier than women (50.5 versus 57.5 years, P<0.001). CHD was the most frequent CVD subtype, and men reached 2% incidence 10.1 years earlier than women (P<0.001). Men and women reached 2% stroke and 1% heart failure incidence at similar ages. Ten‐year CVD event rates diverged at an index age of 35.

Conclusions
Men developed CVD earlier than women, with the greatest difference observed for CHD. Sex differences in CVD risk emerged at 35, persisted through midlife, and were not attenuated by accounting for cardiovascular health.

Giving smokers and ex-smokers a CT scan uncovers cancerous lung tumours when they are at an early enough stage so they can still be removed, found initial results from the UK‘s SUMMIT study, due to be published later this year.

The Guardian reports that the National Health Service (NHS) study that  three out of four lung cancer cases are diagnosed at stage three or four, when it is already too late to give the person potentially life-saving treatment. However, the SUMMIT study, being run by specialists in the disease at University College London Hospital NHS trust, offers real hope that lung cancer can become a condition that is detected early.

CT scanning meant that 70% of the growths detected in people’s lungs were identified when the disease was at stage one or two – a huge increase in the usual rate of early diagnosis.

“It’s really a major breakthrough for lung cancer,” Dr Sam Janes of UCLH, the senior investigator of the trial, is quoted in the report as saying. Lung cancer has never had anything that enabled us to detect this devastating cancer earlier and offer curative treatment to this number of lung cancer patients.”

“It’s important to highlight how effective CT scanning is. In my lung cancer clinic at UCLH, seven out of 10 people have cancer that’s been inoperable, incurable, from the first time they saw a doctor. Whereas with the cancers that we see with Summit, seven out of 10 are potentially curable, because they were detected earlier.

“We have many, many patients who can’t believe their luck that they’ve taken part because they’ve had their scan, they’ve had a nodule – an early cancer – detected, and then they’ve had surgery. People get out of hospital within three to five days and can get back to work or their usual routine within six weeks. That’s stopped them from presenting to a doctor maybe 18 months later with a cancer that has spread and is often incurable.”

According to the report, Janes and his team found 180 cases of lung cancer among 12,100 smokers and ex-smokers aged 55-78 in north central and north-east London, many of whom were from poorer backgrounds. They volunteered to undergo what he called a “lung health MOT” when they received an invitation letter from their GP. Of those, 70% were uncovered when they were still at stage one or two.

Experts say the findings show that the government should move to bring in routine screening of smokers and ex-smokers in order to cut the horrendous death toll from the disease.

“Now that CT screening for lung cancer has been shown to work, we very much hope that a lung cancer screening programme will be introduced in England”, said Dr Robert Rintoul, the chair of the clinical advisory group of the UK Lung Cancer Coalition, a group of leading experts in the disease and patient charities.

“The Summit study will teach us more about how to successfully implement CT screening in a high-risk population”, Rintoul said.

Previous studies in the US and Europe have also shown that CT scanning can find lung cancers that would otherwise have remained hidden.

Details of the SUMMIT study, which started two years ago:

The SUMMIT Study, which will begin in early 2019, has two aims: to detect lung cancer early amongst at-risk Londoners when the chance of successful treatment and survival from Britain’s biggest cancer killer is greatest; and to support the development of a new blood test for the early detection of multiple cancer types, including lung cancer.

In addition, the study will provide evidence to inform a potential national lung cancer screening programme. Currently in England, people are offered screening for breast, bowel and cervical cancer, but not lung cancer.

“Lung cancer is the biggest cancer killer in the UK because most people only experience symptoms when the cancer is at an advanced stage when it is very difficult to treat,” said Professor Sam Janes (UCL Medicine and UCLH), chief investigator of the SUMMIT Study, said.

“This large-scale study gives us a unique opportunity to detect lung cancer much earlier when treatment is more likely to be successful amongst those proven to be most at risk – people who smoke or used to smoke, aged between 50 and 77,” he said.

The study is a key work programme of the UCLH Cancer Collaborative, which brings together healthcare organisations across north and east London, to improve early cancer diagnosis, outcomes and care for patients.

The SUMMIT Study will be delivered by UCLH in close collaboration with UCL and GRAIL, Inc., a US healthcare company focused on the early detection of cancer.

The study aims to recruit approximately 50,000 men and women aged 50-77 from north and east London. Half of the participants will be people at high risk of lung and other cancers due to a significant smoking history (Group A), and the other half will be people who are not at high risk for cancer based on smoking history (Group B). All participants will provide a blood sample, which GRAIL will analyse to evaluate whether lung or other cancers can be detected early through genomic signals in the blood.

Participants in Group A will be identified by inviting residents of north and east London who may meet the eligibility criteria based on their smoking history for a lung health check. In addition to providing a blood sample, participants who are eligible and decide to join Group A will be screened for lung cancer using a low dose CT scan (imaging technology proven to detect lung cancer). The SUMMIT Study will also offer smoking cessation support to smokers who would like to stop.

People in Group B will be invited via a letter from their general practitioner, and eligible and interested participants will also donate a blood sample and fill out a questionnaire.

One in two people will be diagnosed with cancer in their lifetime; lung cancer alone causes around 35,000 deaths per year in the UK. Early diagnosis is key to effective treatment and increasing survival for all cancers, but particularly for lung cancer: currently around 75% of lung cancers are diagnosed at a late stage – stages 3 and 4. Only 25% are diagnosed at the earlier stages 1 and 2.

If diagnosed at the earliest stage, 70% of lung cancer patients will survive for at least a year, compared to around 14% for people diagnosed with the most advanced stage of the disease.

Professor Geoff Bellingan (UCL Medicine), medical director for cancer and surgery at UCLH, said: “The SUMMIT Study provides us with a once-in-a-lifetime opportunity to change how lung cancer is diagnosed – both by paving the way for a national screening programme here in the UK and supporting global efforts to develop a novel blood test for early detection of multiple cancers, including lung cancer.”

Professor Mark Emberton (Dean, UCL Faculty of Medical Sciences), commented: “The SUMMIT study is wonderful opportunity to deliver cutting edge care to a large portion of London and save lives. We are working with a US company to build a team of clinicians and scientists that can really make a difference in the early detection of both lung cancer and other types of cancer through the development of blood tests.”

[link url=”https://www.theguardian.com/society/2021/feb/14/ct-scan-catches-70-of-lung-cancers-at-early-stage-nhs-study-finds”]Full report in The Guardian (Open access)[/link]

Recent research has found that current lung cancer screening guidelines could be missing most cases, prompting calls for changes to detect the disease earlier, reports The Washington Post.

Jessie Creel’s cough started in May last year.

At the time, a primary care physician diagnosed the mother of three with pneumonia. But the antibiotics didn’t work and her cough persisted. Then, during a camping trip, she coughed up blood. She kept losing weight. She couldn’t sleep.

Six months later, Creel, then 42, was diagnosed with stage four lung cancer. She was active, a runner and a swimmer, didn’t drink, and had never even held a cigarette.

More diagnoses like hers are prompting cancer and public health experts to call for changes to lung cancer screening guidelines.

Under current recommendations, people are eligible for screening if they are 50 to 80-years-old and have a history of heavy smoking, either actively or in the past 15 years. But those guidelines exclude a large number of people who could have their cancer detected earlier, according to a study published recently in JAMA Network Open.

The study indicated that of the roughly 1 000 patients treated for lung cancer at Northwestern Medicine, only one-third met requirements for screening. The researchers noted that women, minorities and people who never smoked were disproportionately excluded.

“A majority of the lung cancer patients in this country would not meet the screening criteria as it exists currently,” said Ankit Bharat, the study’s lead author and executive director of the Canning Thoracic Institute at Northwestern Medicine. “If we have a broader screening programme, similar to breast and colon, then we would be able to detect substantially more patients at earlier stage.”

If screening were made available for anyone between the ages of 40 and 85, researchers estimate that nearly 94% of lung cancer cases could be detected, preventing at least roughly 26 000 deaths each year if even 30% of people got screened.

“Lung cancer is the biggest cause of cancer deaths in this country,” Bharat said. “It kills more people than breast, colon and prostate combined.”

He and other experts said the study’s findings highlight that the cancer should no longer be seen as just a smoker’s disease.

“If I had come in presenting a totally different phenotype of like a heavy drinker and heavy smoker, I would have been screened,” Creel said. “It would have been a different result. We have such stereotypes about what lung cancer looks like.”

How is lung cancer detected?

Those who are eligible for screening should get a low-dose CT scan annually, according to the US Preventive Services Task Force, an independent panel of medical experts who recommend screenings and services to keep Americans healthy.

These scans, which are covered by insurance for people who meet the USPSTF screening requirements, use far less radiation than conventional CT scans and have been shown to be able to detect early lung cancers, as well as other conditions, according to medical experts.

Some doctors say they recommend screening using the American Cancer Society’s guidelines, which are slightly different and do not guarantee full insurance coverage. The influential group says anyone aged 50 to 80 with a history of heavy smoking, regardless of when you might have quit, should be screened annually.

“When lung cancers are detected early through lung cancer screening, they are highly curable,” said John Heymach, chair of thoracic/head and neck medical oncology at MD Anderson Cancer Centre in Texas. “In all the studies, we see cure rates above 90%.”

Lung cancer can also be caught at earlier stages in people who get CT scans for unrelated reasons. But experts say many people who don’t meet the screening guidelines are often diagnosed with advanced disease because the cancer isn’t found until they’re showing symptoms.

“Waiting for symptoms leads to most patients having a Stage 4 diagnosis,” said Narjust Florez, a thoracic medical oncologist and co-director of the Young Lung Cancer Programme at the Dana-Farber Cancer Institute in Boston.

By the time Creel got a CT scan, the cancer had spread to her brain, bones and lymph nodes.

“I had known it was definitely outside my lungs,” she said. “Did I expect it to be everywhere that it was? Absolutely not.”

What needs to change?

Official recommendations for lung cancer screening take into account smoking habits, but smoking rates have decreased, Heymach said. Meanwhile, he and other experts say they’re seeing more cases of lung cancer in non-smokers or people who haven’t smoked for at least 15 years.

“The population we’re screening is a smaller and smaller percentage of the whole lung cancer population,” he added. “Low-dose screening CT works, but we’re just not screening enough people.

”The findings in the latest study are “really shocking”, said Heymach, who was not involved in the research.

“It shows that if we kept the current guidelines, we would only catch about one-third of new lung cancers.”

The research suggests that switching to universal age-based screening could save thousands of lives each year – an estimate greater than the number of people who die of brain cancer, Heymach said.

“Imagine if we said that implementing this screening would be like eradicating a whole disease like brain cancer,” he said. “Who wouldn’t think that’s a worthwhile thing to do?”

Changing screening guidelines could also be a cost-effective move, Bharat said. The study found that if age-based screening caught 30% of cases at stage one, it would help save nearly $25bn annually in treatment costs, an amount much greater than the price of broadening access to scans.

Since her diagnosis, Creel has undergone multiple rounds of chemotherapy and a surgery that resulted in the removal of the right upper lobe of her lung. She is also on a prescription medicine used to treat non-small cell lung cancer.

How to lower that risk

People who are eligible should talk to their doctors and schedule a scan. Lung cancer screening rates among people who should be getting tested are low, said Alexis Chidi, a thoracic surgeon and co-director of the Lung Cancer Screening Programme at Memorial Sloan Kettering Cancer Centre.

State-level data suggest between 9% and about 30% of eligible people get screened, one recent study found.

“In addition to making sure that we’re expanding screening criteria, I think a really important part of this is making sure people are getting to screening and that we eliminate the barriers, which are not just based on the guidelines,” Chidi said.

In many cases, she noted, people who are eligible see their healthcare providers every year and never have a discussion about screening. For others, worries about costs, transportation, or time away from work can make the screening process more challenging.

It’s also important to increase screening for people who are at the highest risk, she said.

Among people who are not eligible to be screened, experts say, those worried about their lung cancer risk aren’t left with many options.

Conventional CT scans are available – and they are expensive out of pocket and usually require a physician to sign off.

The Washington Post article – Why screening for the deadliest cancers in the US misses some out (Restricted access)

See more from MedicalBrief archives:

Updated US guidelines urge more lung cancer screening

UK offers free lung screening for ex-smokers in early detection drive

Late diagnosis by GPs link to lung cancer mortality — UK report

CT scan catches 70% of lung cancers at early stage — SUMMIT study