Screenings if you smoke or used to

Smoking history changes two screenings: a yearly lung scan and a one-time ultrasound of the aorta for men. It also brings one recommendation that matters more than either: help to quit. Here is who each applies to, in the USPSTF's terms, and where Medicare and the American Cancer Society differ.

Work out your pack-years first. Packs per day times years smoked; 1 pack is 20 cigarettes. The pack-year calculator does it for you, period by period, and nothing you enter leaves your browser.

At a glance

Screenings and services that depend on smoking history, with who they are for and how often
What	Who (USPSTF)	How often	Source
Lung cancer: low-dose CT	50 to 80, at least 20 pack-years, smoke now or quit within 15 years	Every year	USPSTF, 2021, grade B
Abdominal aortic aneurysm: ultrasound	Men 65 to 75 who have ever smoked	Once	USPSTF, 2019, grade B
Help to quit	All adults who smoke	At every visit: ask, advise, offer support and medicines	USPSTF, 2021, grade A

Lung cancer: a yearly low-dose CT

The USPSTF recommends a low-dose CT scan every year for adults 50 to 80 with at least a 20 pack-year smoking history who smoke now or quit within the past 15 years (grade B). Screening stops once you have not smoked for 15 years, or if a health problem substantially limits life expectancy or the ability or willingness to have lung surgery. (USPSTF, 2021)

Medicare covers a yearly scan at 50 to 77, with no symptoms, at least 20 pack-years, smoking now or quit within 15 years, and an order from your provider. Before the first scan you need a visit to talk through benefits and risks. You pay nothing if the provider accepts assignment. (Medicare.gov)
The American Cancer Society recommends a yearly scan at 50 to 80 for people who smoke or used to smoke and have at least 20 pack-years. Its criteria do not include the 15-year limit on years since quitting. (ACS, 2024)

Screening does not replace quitting. The USPSTF says screening does not prevent most lung cancer deaths, so stopping smoking remains essential, and anyone who still smokes should get help to quit. (USPSTF, 2021) If a scan finds something, see what usually happens after an abnormal lung scan.

Abdominal aortic aneurysm: one ultrasound for men 65 to 75

An abdominal aortic aneurysm is a bulge in the main blood vessel in the belly. Smoking is the strongest predictor of having one, and of how fast it grows and whether it bursts, the USPSTF says. "Ever smoked" is commonly defined as 100 or more cigarettes in your life. (USPSTF, 2019)

USPSTF 2019 abdominal aortic aneurysm screening grades by sex and smoking history
Group, 65 to 75	USPSTF says	Grade
Men who have ever smoked	One ultrasound	B
Men who have never smoked	Offer selectively, not to all	C
Women who have ever smoked, or with a family history	Evidence insufficient	I
Women who have never smoked and have no family history	Do not screen routinely	D

Source for the table: USPSTF, Abdominal Aortic Aneurysm: Screening, 2019.

Medicare covers one screening ultrasound in your lifetime, with a referral, if you have a family history of aortic aneurysm or are a man 65 to 75 who has smoked at least 100 cigarettes. (Medicare.gov)

Help to quit: the grade A recommendation

The USPSTF recommends that clinicians ask all adults about tobacco, advise those who use it to stop, and provide behavioral support and FDA-approved medicines to adults who are not pregnant (grade A). (USPSTF, 2021) What works, and the rules in pregnancy, are on quitting smoking.

Free help: call 1-800-QUIT-NOW (1-800-784-8669) to reach your state quitline, or 1-855-DÉJELO-YA (1-855-335-3569) in Spanish. (Smokefree.gov)

Everything else stays the same

Smoking history does not change the ages for the other screenings, such as blood pressure, colorectal, breast or cervical cancer. Your screening plan includes the lung and aortic screenings when you tick the smoking boxes, alongside everything else for your age and sex.

A breathing test for COPD is not a screening for people without symptoms: the USPSTF recommends against it (grade D). (USPSTF, 2022) A cough, phlegm or shortness of breath are symptoms to tell your doctor about. What the test involves and what the numbers mean: spirometry and COPD screening.

Questions people ask

What screenings should a smoker get?

Under the USPSTF: a yearly low-dose CT for lung cancer at 50 to 80 with a 20 pack-year history, a one-time ultrasound for an abdominal aortic aneurysm for men 65 to 75 who have ever smoked, and help to quit at every visit. The other age-based screenings apply as for anyone else. (USPSTF, 2021) (USPSTF, 2019) (USPSTF, 2021)

I quit smoking. Do I still need lung cancer screening?

Under the USPSTF, yes if you quit within the past 15 years and meet the age and pack-year criteria; screening stops once you have not smoked for 15 years. The American Cancer Society lists people who used to smoke without a limit on years since quitting. (USPSTF, 2021) (ACS, 2024)

What counts as having "ever smoked" for the aortic aneurysm scan?

The USPSTF notes that an "ever smoker" is commonly defined as someone who has smoked 100 or more cigarettes. Medicare uses the same 100-cigarette line for men 65 to 75. (USPSTF, 2019) (Medicare.gov)

Does Medicare cover lung cancer screening?

Yes, once a year at 50 to 77 with no symptoms, at least 20 pack-years, smoking now or quit within 15 years, and an order from your provider. Before the first scan you need a visit to discuss benefits and risks. (Medicare.gov)