Population-Level Trends in Lung Cancer Mortality and Stage Distribution During the USPSTF LDCT Guideline Era: A Multi-Database Quasi-Experimental Study.

IntroductionIn 2013, the United States (U.S.) Preventive Services Task Force recommended low-dose computed tomography (LDCT) for lung-cancer screening. We assessed temporal, population-level changes in incidence, stage at diagnosis, and mortality before and after this recommendation among adults aged 55-79 years.MethodsUsing the US Centers for Disease Control and Prevention Wide-ranging Online Data WONDER (CDC WONDER), Global Burden of Disease (GBD), and SEER data, we examined age-adjusted incidence (AAIR) and mortality (AAMR) trends. Joinpoint regression and interrupted time-series (ITS) models evaluated pre- and post-2014 changes in population-level trends; counterfactual analyses estimated differences between observed outcomes and projections based on pre-2014 trends. SEER was used to characterize stage distributions (localized, regional, distant).ResultsPost-2014 declines accelerated across data systems. Annual AAMR decreased by 3.03% in CDC WONDER and 2.58% in GBD; AAIR declined by 1.85% and 2.37%, respectively. SEER showed a higher proportion of localized disease and fewer distant-stage diagnoses after 2014; joinpoint analyses identified a 2013 inflection with steeper declines in distant-stage incidence thereafter. In models extrapolating pre-2014 trends to subsequent years, observed deaths were lower than counterfactual projections by 28,168 in CDC WONDER and 6,906 in GBD. As an exploratory indicator, mortality-to-incidence ratios declined nationally and in both sexes.ConclusionsDuring the USPSTF LDCT guideline era, independent national datasets showed accelerated mortality declines and a shift toward localized-stage diagnoses. These convergent findings are temporally consistent with real-world benefits of LDCT screening, but they should be interpreted within a broader context that includes continued reductions in smoking, gradual screening uptake, and major therapeutic advances. The findings are hypothesis-generating and do not estimate the isolated causal effect of LDCT screening.