Background: In 2013, the USPSTF recommended screening for lung cancer with low-dose chest computed tomography (LDCT). This was based on the results of the National Lung Screening Trial which showed a 20% relative reduction in mortality from LDCT compared with chest radiography. In Feb/March 2015, the Centers for Medicare and Medicaid (CMS) provided screening guidelines and they and private insurers started covering the cost of LDCT. The impact of this recommendation in the real-world setting is unknown. We investigated the impact of LDCT recommendations on the incidence of advanced lung cancer (a-LCa) in the US general population. We sought to verify that the implementation of LDCT will yield an earlier lung cancer diagnosis and thereby reduce the incidence of later stages of lung cancer. Methods: From the Surveillance, Epidemiology, and End Results (SEER) 18 registries database, we identified adults 55-80 years diagnosed with regional or metastatic (advanced) lung cancer from 2004 to 2018. Age-adjusted incidence rates (AAIR) of advanced lung cancer in 2004-2014 (Pre-LDCT) and 2015-2018 (Post-LDCT) were compared using interrupted time series (ITS) regression analyses. Analyses were stratified by sex, race, and residence. Results: A total of 400,343 patients who met the study criteria were included. Of these, 219,828 (55%) were women and 76% (n = 304,801) were non-Hispanic White. At all periods, the AAIR of a-LCa was highest in non-Hispanic Blacks. Overall, there was a 41% decline in the AAIR of a-LCa in the post-LDCT period compared to the pre-LDCT era (Annual decline of 7.6 vs 4.5 /100,000 person-years (PY) for 2015-2018 vs 2004-2014, p < 0.01). Women experienced a more accelerated decline in the AAIR of a-LCa compared to men (53% versus 30%). By race, the annual rates of a-LCa declined most rapidly among non-Hispanic Blacks (55%, 9.5/ 100,000 PY, 2015-2018 vs 4.7/100,000 PY, 2004-2014, p < 0.01), and the slowest rate of decline was among Hispanics (41%, 4.6/100,000 PY,2015-2018 vs 2.7/100,000 PY, 2004-2014, p < 0.01). By residence, non-metropolitan dwellers experienced a greater decline in annual rates of a-LCa compared with metropolitan dwellers (non-Metropolitan: 69%, 10.1/100,000 PY, 2015-2018 vs 3.2/100,000 PY 2003-2014, p < 0.01: Metropolitan dwellers: 37%, 7.2/100,000 PY 2015-2018 vs 4.5/100,000 PY, p < 0.01). Conclusions: Using population-based data we found a significant decline in rates of a-LCa following the adoption of LDCT for lung cancer screening in the US. Rates of decline in the incidence of a-LCa, however, varied among subgroups. Non-Hispanic Blacks, women, and rural dwellers experienced the most decline in annual rates of a-LCa from 2015 to 2018. Our study shows the overall benefit of LDCT in marginalized communities. However, the impact of our findings on lung cancer mortality will still need further study.