PhD Student University of North Carolina at Chapel Hill Carrboro, United States
Background: Lung cancer screening by low-dose computed tomography (LDCT) reduces lung cancer mortality through earlier diagnosis and treatment. While the US Preventative Services Task Force (USPSTF) issued a grade B recommendation for annual LDCT to those who are at high risk based on age and smoking history, uptake in clinical practice is low.
Objectives: To describe contemporary patterns of lung cancer screening uptake in the US from 2017 to 2021.
Methods: We used data from the Centers for Disease Control and Prevention's 2017-2021 Behavioral Risk Factor Surveillance System (BRFSS). Screening eligibility was determined per USPSTF 2013 recommendation of those ages 55-80 years who are current or former (quit within the last 15 years) smokers with a smoking history of ≥30 pack-years. Current age of respondent, smoking status, and sociodemographic and clinical characteristics were obtained from the BRFSS standard core component questions. Age at smoking initiation, age when last smoked regularly, average number of cigarettes smoked per day, and whether respondent had a CT scan in the past year to check for lung cancer were ascertained from the BRFSS optional lung cancer screening module. The number of years smoked was obtained by subtracting the age of smoking initiation from the age last smoked regularly for former smokers and from current age for current smokers. Pack-years of smoking were calculated by dividing the average number of cigarettes smoked per day by 20 and multiplying by the number of years smoked. Weighted frequencies and means were calculated to assess LDCT screening utilization across calendar year and by sociodemographic characteristics, accounting for survey sampling.
Results: There were 11, 8, 20, 5, and 7 states that participated in the BFRSS- Lung Cancer Screening module from 2017-2021. Over the study period, 3-4% of individuals were eligible for lung cancer screening. The weighted percentage of screened individuals among those eligible were 14%, 18%, 15%, 19%, 19%, respectively. The median age among those screened ranged from 62 in 2018 to 66 in 2021. Among those under age 65 eligible for screening, the weighted percentage of individuals screened was the lowest (11%) in 2017, rose to 18% in 2018, and hovered around 13-15% in 2019-2021. Among the non-Hispanic Black population eligible for screening, the weighted percentage of individuals screened remained under 16% from 2017 to 2019 but rose to 20% in 2020. Among the uninsured eligible population, screening uptake was low, varying around 5% in all years.
Conclusions: Lung cancer screening uptake continues to remain low. Targeted screening outreach is needed for specific subgroups, defined by race and ethnicity and insurance status, to increase equitable access to early cancer treatment that can improve outcomes.
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