Nearly 5 million additional Americans should have annual lung cancer screenings, according to American Cancer Society guidelines that were updated Wednesday.

The ACS is now recommending yearly screenings for people ages 50 to 80 who are current or former smokers and smoked at least one pack of cigarettes a day for 20 or more years.

Under its previous guidelines, which had not been updated since 2013, the ACS called for people 55 to 74 years old who currently smoked or quit within the previous 15 years and smoked at least one pack of cigarettes a day for 30 or more years to be tested. The updated recommendation removes any consideration for how many years have passed since someone quit smoking.

The new guidelines were published Wednesday in CA: A Cancer Journal of Clinicians. The ACS said it monitors medical and scientific literature for new evidence that supports a change to its recommendations. 

“This updated guideline continues a trend of expanding eligibility for lung cancer screening in a way that will result in many more deaths prevented by expanding the eligibility criteria for screening to detect lung cancer early,” Dr. Robert Smith, senior vice president of early cancer detection science at the American Cancer Society and lead author of the guideline report, said in a statement. “Recent studies have shown extending the screening age for persons who smoke and formerly smoked, eliminating the ‘years since quitting’ requirement and lowering the pack per year recommendation could make a real difference in saving lives.”

Lung cancer is the leading cause of cancer death in the United States. ACS researchers estimate there will be 238,340 new cases of lung cancer diagnosed in the United States in 2023 and about 127,000 lung cancer deaths. 

The rate of cancer deaths, however, has been in steady decline, which the ACA attributes to fewer people smoking and advancements in early cancer detection and treatment. In 2020, there were 31.8 deaths per 100,000 people in the U.S., down from 59 per 100,000 in 1993.

While anyone at any age can get lung cancer, about seven in 10 people diagnosed with the disease are 65 or older, according to the ACS.

The recommended annual screening test for lung cancer is a low-dose CT scan. 

The ACS said people who have health conditions that would greatly limit their life expectancy or affect their ability or willingness to receive lung cancer treatment if diagnosed with cancer should not be screened.