Pack-Year Smoking History Is An Inadequate and Biased Measure to Determine Lung Cancer Screening Eligibility

The use of pack-year smoking history to determine screening eligibility in the 2021 United States Preventive Services Task Force (USPSTF) lung cancer screening guideline is based on historic precedent, not epidemiologic evidence, and may exclude many individuals at high risk for lung cancer. It is unclear whether using a smoking duration cutoff instead of a smoking pack-year cutoff would improve the selection of individuals for screening.