Less than 20% of eligible individuals in the US are up-to-date with lung cancer screenings, with the lowest rates in uninsured and Southern populations.

RT’s Three Key Takeaways

  1. Low Screening Rates: Less than 20% of eligible individuals in the United States are up-to-date with recommended lung cancer screenings, indicating a gap in preventive care.
  2. Disparities in Access: Screening uptake is particularly low among uninsured individuals and residents of Southern states, which have the highest lung cancer mortality rates.
  3. Impact of Medicaid Expansion: States that have expanded Medicaid and increased screening capacity show higher rates of up-to-date lung cancer screenings, highlighting the importance of accessible healthcare in improving early detection.

A new study led by American Cancer Society researchers shows less than one in five eligible individuals in the United States were up-to-date with recommended lung cancer screening. 

The screening uptake was much lower in persons without health insurance or usual source of care and in Southern states with the highest lung cancer burden. The findings were published in JAMA Internal Medicine.

“Although lung cancer screening rates continue to be considerably low, this research does show an improvement over screening rates reported for previous years,” says Priti Bandi, PhD, scientific director of cancer risk factors and screening surveillance research at the American Cancer Society. “But we clearly, still have a long way to go. We must push harder to move the needle in the right direction.”

Screening Guidelines and Study Methodology

The United States Preventive Services Task Force (USPSTF) and the American Cancer Society recommend annual lung cancer screening with low-dose computed tomography in eligible high-risk individuals for early detection of the disease. High-risk individuals, according to the  USPSTF, are 50-80 years old, with a 20 pack-year or greater smoking history and currently smoking or quit less than 15 years ago.

For the study, researchers analyzed data from the 2022 Behavioral Risk Factor Surveillance System, a cross-sectional, population-based, nationwide state-representative survey. Self-reported up-to-date lung cancer screening (defined as past-year) prevalence according to the 2021 USPSTF eligibility criteria was studied in respondents 50-79 years of age. Adjusted prevalence ratios and 95% confidence intervals compared differences.

Study Results and Regional Disparities

Study results showed among 25,958 sample respondents eligible for lung cancer screening, 61.5% reported currently smoking, 54.4% were male, 64.4% were aged 60 years of age or older, 78.4% were White persons, and 53% had a high-school education or less. Up-to-date lung cancer screening prevalence was 18.1% overall but varied three-fold across states (range, 31% to 9.7%) with relatively lower levels in Southern states characterized by a high lung cancer mortality burden.

Up-to-date lung cancer screening prevalence increased with age (50-54 years old: 6.7% vs 70-79 years old: 27.1%) and number of comorbidities (≥3: 24.6% vs none: 8.7%). Just 1 in 20 persons without insurance or a usual source of care were up-to-date with lung cancer screening, but state-level Medicaid expansions (adjusted prevalence ratios: 2.68, 95% CI, 1.30, 5.53) and higher screening capacity levels (high vs low, adjusted prevalence ratios: 1.93, 95% CI: 1.36, 2.75) were associated with a higher up-to-date lung cancer screening prevalence.

Importance of Early Detection and Policy Implications

“Early detection with [lung cancer screening] is critical because lung cancer symptoms often don’t appear in the early stages, but when diagnosed and treated early, survival is markedly improved,” says Bandi in a release. “National and state-based initiatives to expand access to healthcare and screening facilities are needed to continue to improve, prevention, early detection and treatment for lung cancer to help save lives.”

Lisa Lacasse, president of the American Cancer Society Cancer Action Network, adds in a release, “This research further amplifies the critical need for reducing all barriers to access to care to ensure people are able to immediately utilize preventive and early detection screenings at no cost. Expanding Medicaid in the 10 states that have yet to do so would significantly improve access to these lifesaving screenings and decrease lung cancer deaths, as well as eliminating patient costs for screening and follow-up tests by all payers, bringing us closer to ending cancer as we know it, for everyone.”

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