The United States Preventative Services Taskforce recently updated lung cancer screening guidelines for U.S. adults with high-risk smoking histories. This has generated a previously undescribed patient population in which the prevalence of cigarette and e-cigarette use has not been described.
We performed a cross-sectional study using population-based data from the Behavioral Risk Factor Surveillance System (2017–2018). We defined lung cancer screening eligibility as adults 50–80 years old with ≥ 20 pack-year smoking history who were currently smoking or quit within the last 15 years. We assessed several smoking-related outcomes including current cigarette use, ever e-cigarette use, and current e-cigarette use among respondents.
Among 7541 screening-eligible adults, current cigarette use was reported by 3604 (47.8%) participants. Ever and current e-cigarette use were reported by 3003 (39.8%) and 670 (8.9%) participants, respectively. Compared to individuals who were previously eligible for screening, individuals newly eligible for screening (i.e., between 50 and 55 years old with a 20–30 pack-year smoking history) were more likely to currently smoke (aOR 1.828, 95% CI 1.649–2.026, p < 0.001). While newly eligible respondents were more likely to report a history of ever using an e-cigarette (aOR 1.144, 95% CI 1.034–1.266, p = 0.009), current e-cigarette use was similar in this group compared to those individuals who were previously screening-eligible (aOR 1.014, 95% CI 0.844–1.219, p = 0.88).
Cigarette and e-cigarette exposure are common among U.S. adults who are eligible for lung cancer screening. Expanded USPSTF criteria will capture a patient population with greater exposure to both of these products.
The USPSTF recently expanded lung cancer screening eligibility.
Rates of cigarette and e-cigarette use among newly eligible patients are undescribed.
Current smoking was reported by 47.8% of screening-eligible participants.
Ever and current e-cigarette use were reported by 39.8% and 8.9% of participants, respectively.
Individuals newly eligible for screening were more likely to use these products.
Lung cancer is the leading cause of cancer-related mortality in the United States and cigarette smoking is the leading modifiable risk factor for this malignancy . The United States Preventative Services Taskforce (USPSTF) recommends annual lung cancer screening for individuals with high-risk smoking histories . These eligibility criteria were recently broadened to include individuals 50–80 years old (previously 55–80 years old) with a ≥ 20 pack-year smoking history (previously ≥30 pack-year history) who currently smoke or quit within the past 15 years . The expanded criteria are projected to further reduce lung cancer deaths among lower-risk individuals while also reducing disparities in screening eligibility . The prevalence of tobacco use in this newly captured patient population is undescribed compared to the previously eligible screening cohort.
Electronic cigarettes (“e-cigarettes”) have gained popularity as an alternative to traditional cigarettes. While most literature has focused on the alarming trends of e-cigarette use among younger individuals, recent studies have demonstrated that e-cigarette use is significant in older adults, including those with cancer . Use of such products in individuals who are eligible for lung cancer screening is poorly understood, especially in light of the updated USPSTF guidelines. The objective of this study is to describe the prevalence of cigarette and e-cigarette use among U.S. adults eligible for lung cancer screening based on the current USPSTF criteria.