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.

Australia has launched a government-funded lung cancer screening program that provides biennial low-dose CT scans to patients who are either current heavy smokers or who have quit in the past decade.

The screening program is a “game-changer” for Australia, Lucy Morgan, MD, PhD, respiratory physician at Concord and Nepean Hospitals in Sydney, told Medscape Medical News. “This [program] gives us the opportunity to offer cure to people who would otherwise develop Australia’s most deadly cancer.” Morgan is also chair of the Lung Foundation Australia and a member of the screening program’s expert advisory committee.

Early Diagnosis Crucial 

Lung cancer is the fifth most diagnosed cancer in Australia and the most common cause of cancer death, claiming around 9000 lives per year. Survival rates for lung cancer (around one quarter of those diagnosed survive for 5 years) are far below those of more common cancers, including breast cancer, which has a 5-year survival rate of above 90%, and colorectal cancer, which has a 5-year survival rate of above 70%.

The reason for the low survival rate of lung cancer is that by the time it is symptomatic, it’s often advanced, said Shalini Vinod, MD, radiation oncologist at the University of New South Wales Sydney. “Approximately in half the cases that I pick up, the cancer has spread beyond the lungs and so is incurable,” said Vinod, who is on the expert advisory committee for the program.

Lung cancers that are detected early, before they have spread, have a much better prognosis and better treatment options, Vinod said. The most common approach for early lung cancer is surgery to remove the tumour or radiotherapy. “If they’re 2 centimetres or less, they’re eligible for minimally invasive surgery…where rather than taking a whole lobe of the lung out, you can just take a part of the lobe with equivalent outcomes,” she told Medscape Medical News.

The program, which was launched on July 1, is recruiting smokers aged 50-70 years who currently smoke or have quit in the past 10 years and have a smoking history of at least 30 pack-years.

Only a handful of countries worldwide, including the United States, the United Kingdom, South Korea, Taiwan, and Canada, have national or regional lung cancer screening programs, which all vary slightly in the choice of screening interval, age range, and smoking history. For example, the US Preventive Services Task Force recommends yearly screening.

The choice of 2-yearly screening was an effort to balance cost and benefit, said Henry Marshall, MD, PhD, a thoracic physician at the Prince Charles Hospital and University of Queensland Thoracic Research Centre in Brisbane. “It’s as effective in terms of its health benefit, but of course a lot cheaper because you’re immediately halving the number of scans that you need to do,” said Marshall, who is also a member of the screening program expert advisory committee.

Australia’s Unique Challenges

Australia faces unique challenges in implementing a national screening program like this one. The first is that lung cancer is the most diagnosed cancer and the most common cause of cancer death among Aboriginal and Torres Strait Islander people, with incidence and mortality rates around twice those of non-Aboriginal Australians.

“Some of it is about living in rural and remote Australia, some of it is about smoking rates, some of it is probably about genetic predisposition; we don’t understand that completely,” said Morgan. “And much of it is about access to health care.”

To address this disparity, the program was developed in partnership with the Aboriginal Community Controlled Health Organisation sector and First Nations people to ensure that the design and implementation was community-led and culturally appropriate and that the information and education materials were tailored to the community.

The program includes a mobile CT screening service to reach Australians in rural and remote areas because “there are millions of Australians living more than four hours away from a CT scanner,” said Morgan. Five mobile screening trucks will be deployed around the country beginning in November this year.

Participants must be initially referred for screening by their general practitioner (GP). If anything is detected on CT, they are then referred to another clinician according to a nodule management protocol that was developed specifically for the program.

The Royal Australian College of General Practitioners has expressed concern about the potential increased workload for GPs, particularly those in areas of socioeconomic disadvantage, where greater numbers of patients are likely to have histories of heavy smoking and therefore be eligible for screening.

The program will also lead to increased pressure on radiology and cardiothoracic surgery services in Australia, Vinod said, but another concern is whether smokers will actually sign up for the program. Uptake for breast cancer screening in Australia is around 50%, and uptake for bowel cancer screening is around 40%. “If you just benchmark it against those, this is going to be tough because this is a cancer where there is a lot of stigma,” Vinod said.

Vinod, Morgan, and Marshall are members of the National Lung Cancer Screening Program Expert Advisory Committee. They reported having no relevant financial relationships.

A novel brain-based “aging” clock can accurately and reliably estimate how quickly an individual is biologically aging from a single MRI scan, offering a potential tool to help clinicians predict the risk for dementia, mild cognitive impairment, and other chronic diseases, a new study showed.

Investigators developed the Dunedin Pace of Aging Calculated from NeuroImaging (DunedinPACNI) to estimate an individual’s pace of aging based on brain MRI features such as cortical thickness, surface area, gray matter volume, gray-to-white matter contrast, subcortical volumes, and ventricular sizes.

In a series of studies with more than 50,000 brain MRI scans from people aged 22-98 years across multiple datasets, those whose biological age outpaced their chronological age not only had poorer cognition, faster hippocampal atrophy, and greater dementia risk but also worse general health, including greater frailty, poorer self-reported health, and greater risk for chronic disease and premature death.

While more research on the new tool is needed, investigators said they expect it will be ready for use in clinical practice in a few years.

“Perhaps our boldest expectation is for DunedinPACNI to become part of routine clinical care across the lifespan as an index of faster aging that can help physicians identify patients at risk for later poor health well before symptoms appear and when prevention efforts can be most effective,” Ahmad R. Hariri, PhD, professor of psychology and neuroscience and director, Laboratory of Neurogenetics, Duke University, Durham, North Carolina, told Medscape Medical News.

The study was published online on July 1 in Nature Aging.

Blood-Based Epigenetic Clock

The DunedinPACE-NI tool builds on earlier research from a long-term study that has followed more than 1000 individuals born in Dunedin, New Zealand, in 1972-1973.

The researchers initially used data from this study to develop DunedinPACE, a blood-based epigenetic clock that uses DNA methylation to estimate the rate of aging. While DunedinPACE has shown strong associations with morbidity, brain aging, and more. Itsy, its application is limited to studies where blood samples are available, the researchers noted.

To overcome this limitation, they developed DunedinPACNI, which uses data from a single standard T1-weighted MRI scan to estimate an individual’s longitudinal pace of aging — a composite index reflecting physiological decline across cardiovascular, metabolic, immune, renal, and other systems.

The researchers trained DunedinPACNI on MRI data from 860 participants in the Dunedin Study, all scanned at age 45. The model incorporated 315 structural brain features. The algorithm for DunedinPACNI is publicly available to the research community.

Applying this measure to the Alzheimer’s Disease Neuroimaging Initiative (ADNI), UK Biobank and BrainLat datasets showed that faster DunedinPACNI scores predicted cognitive impairment, accelerated brain atrophy, and conversion to diagnosed mild cognitive impairment (MCI) or dementia.

For example, in the ADNI sample, individuals deemed to be aging the fastest (top 10%) when they joined the study had a 61% higher risk of progressing to MCI or dementia in the years that followed than average agers. The fast agers also started to have memory problems sooner than those who were found to be aging slower based on DunedinPACNI scores.

In the UK Biobank sample, healthy participants with faster DunedinPACNI at baseline were 14% more likely to be diagnosed with chronic age-related diseases later on.

The fastest agers had an 18% higher risk of being diagnosed with a chronic age-related disease than average agers. Fast aging was also associated with worse cognitive performance, higher frailty, and poorer self-rated health.

Over an average of nearly 10 years of follow-up, those with the fastest DunedinPACNI scores were 41% more likely to die than those who were aging more slowly.

DunedinPACNI also reflects social gradients of health inequities. Faster aging scores were observed in individuals with fewer years of formal education or lower income.

The measure also had similar predictive power for dementia risk and cognitive impairment among Latin American adults in the BrainLat cohort.

“It seems to be capturing something that is reflected in all brains,” Hariri said in a press release.

From Bench to Bedside

“Right now, DunedinPACNI can only tell us if a person is aging faster or slower than others within any given dataset or sample,” Hariri told Medscape Medical News. “That is, DunedinPACNI is currently a relative measure. It doesn’t yet tell us if a person is aging faster or slower than would be expected for any person anywhere in the world who is of the same chronological age. But that is changing quickly.”

Investigators need to develop normative reference charts for DunedinPACNI, similar to what they have done for such measures as height, weight, and BMI, Hariri noted.

“It will take time to analyze the tens of thousands of scans collected across the lifespan necessary to develop these norms, but we’ve already begun to do this. We are confident that reference norms for DunedinPACNI will be ready within the next year and, subsequently, DunedinPACNI can be adopted in clinical practice within a few years,” Hariri said.

Immediate applications of DunedinPACNI in the research setting include using it as an outcome measure in randomized clinical trials of interventions to slow down aging and as a biomarker of accelerated aging that can help predict the chances that an older person will convert from normal cognitive functioning to MCI or from MCI to dementia, Hariri explained.

DunedinPACNI could also be used in clinical trials of AD interventions. This could be as a surrogate outcome measure in younger people decades before they might develop dementia by showing that an intervention slows down aging, which is itself a major risk factor for dementia, Hariri said.

“In older people, DunedinPACNI may be useful as a screening tool to either reduce heterogeneity in the sample by enrolling people all aging at about the same rate or excluding people for are aging faster than others and who may be at increased risk for unintended side effects of treatment including amyloid related imaging abnormalities (ARIAs),” Hariri added.

The authors have filed a patent application for the tool. This research was supported by the US National Institute on Aging, the UK Medical Research Council, and the New Zealand Health Research Council.