Low Screening Rates for Lung Cancer Highlight Public Health Priority

Eligibility criteria for annual lung cancer screening (LCS) among current or former smokers should be updated, with the move going a long way to reduce screening disparities, experts emphasize today in JAMA Network Open. Their comparison of outcomes following the release of screening guidance from the US Preventive Services Task Force (USPSTF) in 2013 and updated in 2021 shows overall poor uptake of annual low-dose CT LCS, despite changes to 2 major criteria that expanded the eligibility pool: Age was lowered to 50 years from 55 to 80 years, and pack-year (PY) smoking history was reduced from 30 to 20.

Despite updated guidance in 2021, overall screening rates for lung cancer remain low | Image Credit: samunella - stock.adobe.com

For this analysis, a former smoker was defined as someone who quit smoking within the past 15 years, reporting a chest CT scan was considered being screened per recommendations, sociodemographic characteristics and state of residence were used to compare LCS prevalence, and CDC and Behavioral Risk Factor Surveillance System (BRFSS) data for 2022 were analyzed for screening outcomes.

Comparing the 2013 vs 2021 eligibility criteria shows a 65.9% jump in total population eligible for LCS, from 8,154,440 to 13,526,348 individuals. The overall screening prevalence also rose per the 2013 and 2021 criteria but to a much smaller degree: from just 16.4% to 19.6%. In particular, for those eligible under the 2021 criteria who were not eligible under the 2013 criteria, 15.3% were aged 50 to 54 years, and of that group, just 5.7% were screened, for an LCS prevalence of 6.1% (95% CI, 5.0%-7.2%).

When looking at PY history, 29.7% of those newly eligible reported a PY history of 20 to 29 years, but a screening rate of 23.8%, for an LCS prevalence of just 13.5% (95% CI, 11.8%-14.5%). Approximately 60% also reported being a current smoker vs 55.2% eligible for screening under the 2013 USPSTF guidance. Additionally, 56.2% vs 51.5%, respectively, of this group reported a screening, which equated to an LCS prevalence of 15.4% (95%CI, 14.4%-16.4%) vs 18.3% (95% CI, 16.8% vs 19.8%).

Most of those newly eligible were White, which remained unchanged overall vs 2013 eligibility (81.9% and 84.3%, respectively), continuing to far outpace individuals of other races and ethnicities:

• Hispanic or Latino: 4.9% and 4.4%
• American Indian or Alaska Native: 2.4% and 2.4%
• Asian: 1.4% and 1.2%
• Black: 8.8% and 6.9%
• Native Hawaiian or Other Pacific Islander: 0.3% and 0.4%
• Multiracial: 0.4% and 0.4%

Still, the study investigators note a link between the expanded criteria and great relative increases in LCS eligibility of 86% among Hispanic individuals, 88% among Asian individuals, and 109% among Black individuals.

Reporting very good down to fair health and having insurance, a health care clinician, a high school diploma/GED or some college, or an annual household income below $25,000 or between $25,000 and $49,000 were linked in both sets of eligibility criteria to higher rates of screening eligibility and of being screened. Also, female patients eligible for screening from 2013 to 2021 rose by 78% vs 57% among male patients, the study authors highlighted.

Breaking results down by state and region, Rhode Island had the highest prevalence of 28.7% and Wyoming the lowest, 8.6%; significant differences were not seen for the District of Columbia, Illinois, Guam, and the Virgin Islands.

“Our findings suggest that updated LCS eligibility criteria may be an important first step to reducing lung cancer disparities, although screening rates remained low," the authors concluded. “Increasing LCS uptake nationwide should be a major public health priority.”

The principal limitation of extrapolating their findings to a wider audience was that the BRFSS LCS data were self-reported.

Reference

Henderson LM, Su IH, Rivera MP, et al. Prevalence of lung cancer screening in the US, 2022. JAMA Netw Open. Published online March 21, 2024.