Lung Cancer Screening Rates Increase but Disparities Persist, Study Finds

Kristin Maki, PhD

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While the prevalence of lung cancer screening has increased, significant disparities persist in screening rates among eligible adults, according to new data. Disparities in screening were identified between states and racial/ethnic groups. Investigators also found that having Medicare coverage or a primary care physician (PCP) played a role in influencing screening rates.¹

The 2019 Behavioral Risk Factor Surveillance System (BRFSS) data exhibited only 12.8% of eligible adults underwent computed tomographic (CT) scans for lung cancer screening, with rates showing a decline during the COVID-19 pandemic. 

In this study, investigators led by Kristin Maki, PhD, Karmanos Cancer Institute, Wayne State University School of Medicine, utilized data from the 2021 BRFSS to estimate lung cancer screening rates and identify factors associated with screening participation.

Who gets screened for lung cancer?

The analysis of data from 2021 showed screening rates increased 8.4% since 2019 to 21.2%. Investigators reported the weighted sample consisted of 112,399 respondents who participated in lung cancer screening.

The sample included adults aged 55 to 79 years with a smoking history of at least 30 pack-years, who either currently smoked or had quit within the past 15 years. The average population age was 65.7 (SD, 5.8), about half were men (49.5%), and the majority were white (86.7%).

Compared with white respondents, the likelihood of screening was higher for those who self-reported belonging to racial and ethnic groups other than white, Black, Hispanic, or multiracial (OR, 8.89 [95% CI, 1.81 - 43.71] P = 0.01).

Based on the multivariable hierarchical logistic regression used to identify associated factors, those who underwent screening had a pack-year smoking history of 57.3 years (SD, 49.6; 95% CI, 50.8 - 63.8) and had quit 6.9 years (SD, 4.6) prior to screening (95% CI, 5.8-8.0).

Factors of Screening Participation

Results indicated 4.5% of individuals who underwent lung cancer screening were uninsured and without Medicare coverage (95% CI, -4.5% - 13.5%). More than a quarter (27.7%) of respondents reported poor health (95% CI, 16% - 39.5%).

The team focused on 4 states: Maine, Michigan, New Jersey, and Rhode Island. The findings demonstrated those in Rhode Island were more likely to participate in screening (95% CI, 1.05 - 3.67) when compared with those in Maine (OR, 5.79), displaying statistical significance (P = 0.03).

An important finding was the increased rate of lung cancer screening seen in individuals who had a primary care physician (OR, 5.62 [95% CI, 1.19 - 26.49] P = 0.03) which emphasizes the significance of having a PCP.

Furthermore, the likelihood of obtaining screening decreased for individuals aged 55 to 64 years (OR, 0.43 [95% CI, 0.23 - 0.81] P = 0.01) and those aged 78 to 79 years when compared with respondents aged 65 to 77 years (OR, 0.17 [95% CI, 0.04 - 0.80] P = 0.02).

Prevalence of LCS in 2021 showed improvement compared with 2019, but the study highlighted screening rates for lung cancer still fall below those of other population-level cancer screening programs and the high percentage of participating individuals who reported poor health is concerning as many may not be healthy enough for treatment of lung cancer.

“Disparities in lung cancer screening uptake among eligible adults remain and will likely continue with the updated USPSTF recommendation increases the number of Black adults who are eligible for lung cancer screening,”^1,2 investigators said. “Research to identify facilitators for lung cancer screening among persons who currently smoke is needed, including a focus on the role of stigma as a barrier to screening.”¹

References:

1. Maki KG, Tan NQP, Toumazis I, Volk RJ. Prevalence of Lung Cancer Screening Among Eligible Adults in 4 US States in 2021. JAMA Netw Open. 2023;6(6):e2319172. doi:10.1001/jamanetworkopen.2023.19172
2. Grossi G. Panagis Galiatsatos, MD: Closing the Gap in Lung Cancer Screening. HCPLive. May 24, 2023. https://www.hcplive.com/view/panagis-galiatsatos-closing-the-gap-lung-cancer-screening