In a study reported in JAMA Internal Medicine, Bandi et al found that only 18% of eligible individuals in the United States were considered up to date—defined as undergoing screening within the past year—for recommended annual lung cancer screening in 2022.
As stated by the investigators, “The U.S. Preventive Services Task Force (USPSTF) recommends annual lung cancer screening with low-dose computed tomography in high-risk individuals (age 50–80 years, ≥ 20 pack-years currently smoking or formerly smoked, and quit < 15 years ago) for early detection of lung cancer.”
Study Details
The study used data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) population-based, nationwide, state-representative survey for respondents aged 50 to 79 years who were eligible for lung cancer screening according to the 2021 USPSTF eligibility criteria. Prevalence of up-to-date lung cancer screening was assessed across all 50 states and District of Columbia (included here as a Southern ‘state’).
Key Findings
Survey response rates ranged from 33.9% to 66.8% across states, with a median rate of 45.1%.
Among 25,958 respondents included in the analysis, the median age was 62 years, 61.5% reported current smoking, 54.4% were male, 64.4% were aged ≥ 60 years, and 53.0% had a high school education or less.
Overall, the up-to-date lung cancer screening prevalence rate was 18.1% in the United States, with rates ranging across states from 9.7% (Wyoming) to 31.0% (Rhode Island). Mean up-to-date lung cancer screening prevalence rates and mean lung cancer mortality burden (age-adjusted mortality rate per 100,000 persons) were:
- 4% and 98.1 among Northeastern states
- 7% and 110.6 among Midwestern states
- 8% and 121.6 among Southern states
- 1% and 75.6% in Western states.
Southern states tended to have lower up-to-date lung cancer screening prevalence rates and higher lung cancer mortality burden; eg, among six states categorized as having low up-to-date lung cancer screening prevalence, the lung cancer mortality burden was ranked as high in four and medium in one.
Up-to-date lung cancer screening prevalence rates increased with age, from 6.7% among individuals aged 50 to 54 years to 27.1 among those aged 70 to 79 years, and with number of comorbidities, from 8.7% for those with no comorbidities to 24.6% for those with three or more comorbidities.
Up-to-date lung cancer screening prevalence was 3.7% among individuals without insurance and 5.1% among those with no usual source of medical care.
Up-to-date lung cancer screening prevalence was higher among those living in 39 Medicaid expansion states vs 12 nonexpansion states among individuals aged 50 to 64 years (adjusted prevalence ratio (APR) = 2.68, 95% confidence interval [CI] =1.30–5.53). Up-to-date lung cancer screening prevalence was also higher among states with higher vs lower screening capacity levels (APR = 1.93, 95% CI = 1.36–2.75).
The investigators concluded, “This study of data from the 2022 BRFSS found that the overall prevalence of up-to-date lung cancer screening [in the United States] was low. Disparities were largest according to health-care access and geographically across U.S. states, with low prevalence in southern states with high lung cancer burden. The findings suggest that state-based initiatives to expand access to health care and screening facilities may be associated with improved up-to-date lung cancer screening rates and reduced disparities.”
Priti Bandi, PhD, of the Surveillance & Health Equity Science Department, American Cancer Society, is the corresponding author for the JAMA Internal Medicine article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
